1528244225 NPI number — DIAGNOSTIC RADIOLOGY & IMAGING, LLC

Table of content: (NPI 1528244225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528244225 NPI number — DIAGNOSTIC RADIOLOGY & IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC RADIOLOGY & IMAGING, 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:
Provider Other Organization Name Type Code:
6
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:
1528244225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 N ELM STREET
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27401-1023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-274-9617
Provider Business Mailing Address Fax Number:
336-482-2177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1635 HWY 66 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-993-5328
Provider Business Practice Location Address Fax Number:
336-993-8957
Provider Enumeration Date:
01/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
AVP REGIONAL OPERATIONS
Authorized Official Telephone Number:
336-540-4322

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5950051 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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