Organization
KEOWEE RADIOLOGY P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE C POLEYNARD MD (PRESIDENT)
(864) 885-7113
Entity
Organization
Contact information
Practice address
298 MEMORIAL DR, SENECA, SC 29672-9443
(864) 885-7113
Mailing address
PO BOX 49009, GREENWOOD, SC 29649-0001
(864) 223-3070
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3270
—
SC
01
—
CH9258
RAILROAD MEDICARE
—
Enumeration date
07/20/2005
Last updated
08/25/2010
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