CLYDE P. BLALOCK (NPI# 1396782488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396782488 |
| Entity Type | Individual |
| Full Name | CLYDE P. BLALOCK |
| Credential | MD |
| Practice Address |
955 Ribaut Rd Beaufort SC 29902-5441 |
| Mailing Address |
Po Box 49009 Greenwood SC 29649-0001 |
| Practice Telephone | 8435225130 |
| Practice Fax Number | 8435225538 |
| Mailing Telephone | 8642233070 |
| Mailing Fax Number | 8642231396 |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2008-01-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
21036 | SC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | G24901 | 05 |
| Street Address |
955 RIBAUT RD |
| City | BEAUFORT |
| State | SC |
| Zip Code | 29902-5441 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366436073 | Beaufort County Memorial Hospital | General Acute Care Hospital | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2005-09-08 |
| 1083270995 | Taylor D Robinson | Nurse Practitioner | 955 Ribaut Rd, Beaufort, SC 29902-5454 | 2019-05-15 |
| 1851868244 | Roxanne Davis Cote | Dietitian, Registered | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2018-10-24 |
| 1023585411 | Jessica Marie Hausfeld | Dietitian, Registered | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2018-10-24 |
| 1366917940 | Lydia C Wickenhoefer | Dietitian, Registered | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2018-10-10 |
| 1871091199 | Michael Conner Seepe | Nurse Anesthetist, Certified Registered | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2018-02-01 |
| 1356849814 | Charlotte Seepe | Nurse Anesthetist, Certified Registered | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2018-01-30 |
| 1063928935 | Beaufort Memorial Hospital - Navy Resource Sharing | General Acute Care Hospital | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2017-12-14 |
| 1548773583 | Beaufort Physician Partners | Clinic/Center | 955 Ribaut Rd, Beaufort, SC 29902 | 2017-11-13 |
| 1982116182 | Harmony Tucker | Physical Therapist | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2017-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063024578 | Beaufort County Memorial Hospital | Family Medicine | Beaufort Memorial Preoperative Assessment Clinic, 989 Ribaut Road Suite 370, Beaufort, SC 29902 | 2020-08-18 |
| 1750992475 | Fayth Polite | Social Worker | 2210 Salem Drive East, Beaufort, SC 29902 | 2020-08-14 |
| 1417509530 | Andrew Grant Miner | Dentist | Naval Hospital Beaufort, 1 Pinckney Blvd., Fpo, AA 29902 | 2019-07-09 |
| 1376029777 | Edward Dela Fuente | Counselor | Coastal Empire Mental Health Center, 1050 Ribaut Road, Beaufort, SC 29902 | 2018-07-18 |
| 1114440419 | Kristin Webb | Registered Nurse | 607 Wilmington Street, Beaufort, SC 29902 | 2017-07-19 |
| 1326582081 | Annemarie Gierling Gault | Nurse Practitioner | Beaufort Memorial Medical Oncology Infusion Center, 989 Ribaut Rd, Ste 103, Beaufort, SC 29902 | 2016-12-14 |
| 1114396579 | Jacquelyn Faith Proulx | Dentist | 1 Pickney Blvd., Naval Hospital Beaufort, Beaufort, SC 29902 | 2015-09-16 |
| 1386028413 | Howard Family Dental - Beaufort, Pllc | Dentist | 35 Robert Smalls Pkwy, Beaufort, SC 29902 | 2015-07-18 |
| 1598018103 | Lisa Marie Johnson | Occupational Therapist | 9555 Ribaut Road, Beaufort Memorial Hospital, Beaufort, SC 29902 | 2012-10-19 |
| 1134497860 | Jeremy Michael Simmons | Pharmacist | 2127 Boundary Street, Suite 19, Beaufort, SC 29902 | 2011-12-08 |
| Find all providers in zip 29902 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972865004 | Nathaniel Jones | Radiology | Po Box 6216a, Beaufort, SC 29902-0313 | 2012-06-14 |
| 1790855674 | Mark Earl Bomia | Radiology | 1 Pinckney Blvd, Beaufort, SC 29902-6122 | 2006-11-08 |
| 1881617843 | Beaufort Medical Imaging Inc | Radiology | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2006-07-25 |
| 1205873395 | William M. Jackson | Radiology | 955 Ribaut Rd, Beaufort, SC 29902-5441 | 2006-05-31 |
| 1851360630 | James Arthur Danigelis | Radiology | 1 Pinckney Blvd, Attn Professional Affairs Coordinator Naval Hospital Be, Beaufort, SC 29902-6148 | 2006-03-15 |
| 1235117359 | Thurman Ray Sherbert | Radiology | 1 Pinckney Blvd, Beaufort, SC 29902-6148 | 2006-01-09 |
| 1336122241 | James A Walsh | Radiology | 1 Pinckney Blvd, Naval Hospital Beaufort, Attn:prof Affairs Coordinator, Beaufort, SC 29902-6122 | 2005-11-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609486786 | Tara Noone | Radiology | 545 Planters Loop, Mount Pleasant, SC 29464-2743 | 2020-08-04 |
| 1447728795 | Island Imaging, LLC | Radiology | 40 Palmetto Parkway, Hilton Head Island, SC 29926 | 2018-11-05 |
| 1417423088 | Bon Secours Diagnostic Imaging | Radiology | 1 Marcus Dr Ste 100, Greenville, SC 29615-4818 | 2018-10-22 |
| 1700352374 | Bon Secours Diagnostic Imaging | Radiology | 2 Innovation Dr Ste 350, Greenville, SC 29607-5269 | 2018-10-22 |
| 1548797533 | Gregory S Connor, Md, Pa | Radiology | 628 W Home Ave, Hartsville, SC 29550-4430 | 2017-05-22 |
| 1407393861 | Mcleod Physician Associates II | Radiology | 1116 W Evans St, Florence, SC 29501-3320 | 2017-01-24 |
| 1932651908 | Long Bay Diagnostic Imaging Murrells Inlet, LLC | Radiology | 4407 Highway 17 Bypass, Murrells Inlet, SC 29576-5097 | 2016-10-26 |
| 1245687540 | John Frederick Hughes | Radiology | 96 Jonathan Lucas St # 323, Charleston, SC 29425-3230 | 2016-05-17 |
| 1295104073 | Arthur Knight Walter | Radiology | 737 River Rd, Columbia, SC 29212-8809 | 2015-09-22 |
| 1386030021 | Shawn Hobby | Radiology | 96 Jonathan Lucas St Charleston Sc 29425, Charleston, SC 29425-0001 | 2015-04-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.