Organization
BEAUFORT MEDICAL IMAGING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLYDE P. BLALOCK (AUTHORIZED OFFICIAL)
(843) 522-5200
Entity
Organization
Contact information
Practice address
955 RIBAUT RD, BEAUFORT, SC 29902-5441
(843) 522-5130
(843) 522-5538
Mailing address
5700 SOUTHWYCK BLVD, TOLEDO, OH 43614-1509
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK8953
RAILROAD MEDICARE
SC
05
—
GP3666
—
SC
Enumeration date
07/25/2006
Last updated
11/04/2019
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