1003030131 NPI number — SUPERIOR DIAGNOSTIC IMAGING INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003030131 NPI number — SUPERIOR DIAGNOSTIC IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR DIAGNOSTIC IMAGING INC
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:
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:
1003030131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16133
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28408-6133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-395-5569
Provider Business Mailing Address Fax Number:
910-395-6969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11550 COMMON OAKS DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27614-7298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-395-5569
Provider Business Practice Location Address Fax Number:
910-395-6969
Provider Enumeration Date:
04/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BADDOUR
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OWNER
Authorized Official Telephone Number:
910-794-6884

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)





Copyright © 2007-2025 www.npivalidator.com