Basic Information
Provider Information
NPI: 1841232311
EntityType: 2
ReplacementNPI:  
OrganizationName: SOUTHEASTERN IMAGING CONSULTANTS OF CARY, LLC
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Mailing Information
Address1: PO BOX 16475
Address2:  
City: CHAPEL HILL
State: NC
PostalCode: 275166475
CountryCode: US
TelephoneNumber: 9199676646
FaxNumber: 9199676647
Practice Location
Address1: 3700 NW CARY PKWY
Address2: SUITE 120
City: CARY
State: NC
PostalCode: 275138422
CountryCode: US
TelephoneNumber: 9196530380
FaxNumber: 9196530388
Other Information
ProviderEnumerationDate: 06/11/2006
LastUpdateDate: 08/22/2020
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AuthorizedOfficialLastName: HOLDER
AuthorizedOfficialFirstName: CHRISTINE
AuthorizedOfficialMiddleName: B
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3368523488
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: RT
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085B0100X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyBody Imaging

ID Information
IDTypeStateIssuerDescription
017NJ01NCBLUE CROSS/BLUE SHIELDOTHER


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