Provider Demographics
NPI:1053353508
Name:SOUTHEASTERN IMAGING CONSULTANTS, LLC
Entity type:Organization
Organization Name:SOUTHEASTERN IMAGING CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:F
Authorized Official - Last Name:EVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-202-5593
Mailing Address - Street 1:PO BOX 16573
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-6573
Mailing Address - Country:US
Mailing Address - Phone:919-967-6646
Mailing Address - Fax:919-967-6647
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8104
Practice Address - Country:US
Practice Address - Phone:919-785-9091
Practice Address - Fax:919-785-9776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015G6OtherBLUE CROSS/BLUE SHIELD
NC89015G6Medicaid
NC2881774Medicare ID - Type Unspecified