1518918481 NPI number — PRESBYTERIAN IMAGING CENTERS LLC

Table of content: (NPI 1518918481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518918481 NPI number — PRESBYTERIAN IMAGING CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN IMAGING CENTERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRESBYTERIAN IMAGING CENTER UNIVERSITY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518918481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2085 FRONTIS PLAZA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON-SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-5614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-277-7226
Provider Business Mailing Address Fax Number:
336-277-9795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8401 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-8797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-384-1580
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARGETT
Authorized Official First Name:
FRED
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EVP CFO
Authorized Official Telephone Number:
704-384-5184

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 293D00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5917808 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00471051 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 615320705 . This is a "NC DOL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 16-42368 . This is a "UHC" identifier . This identifiers is of the category "OTHER".




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