1063499952 NPI number — MOBILE RADIOLOGY & EKG OF CAROLINA, INC.

Table of content: (NPI 1063499952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063499952 NPI number — MOBILE RADIOLOGY & EKG OF CAROLINA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBILE RADIOLOGY & EKG OF CAROLINA, 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:
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:
1063499952
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 17488
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33762-0488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-443-0389
Provider Business Mailing Address Fax Number:
727-442-7851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3575 RUTHERFORD ROAD EXT
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
TAYLORS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29687-2168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-268-0013
Provider Business Practice Location Address Fax Number:
864-268-0590
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARTWRIGHT
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
727-443-0389

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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