Provider Demographics
NPI:1861671711
Name:SOUTHERN MRI
Entity type:Organization
Organization Name:SOUTHERN MRI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-815-4600
Mailing Address - Street 1:40 PALMETTO PKWY
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3759
Mailing Address - Country:US
Mailing Address - Phone:843-681-5636
Mailing Address - Fax:843-681-5639
Practice Address - Street 1:49 PENNINGTON DR STE B
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-9014
Practice Address - Country:US
Practice Address - Phone:843-815-4600
Practice Address - Fax:843-815-4601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN MRI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology