1215261383 NPI number — INMED DIAGNOSTICS SERVICES OF SC LLC

Table of content: (NPI 1215261383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215261383 NPI number — INMED DIAGNOSTICS SERVICES OF SC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INMED DIAGNOSTICS SERVICES OF SC 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:
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:
1215261383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 E COMMERCIAL BLVD
Provider Second Line Business Mailing Address:
SUITE 826
Provider Business Mailing Address City Name:
FT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33308-4054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-510-3700
Provider Business Mailing Address Fax Number:
954-510-2649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1704 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29334-9708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
964-486-8595
Provider Business Practice Location Address Fax Number:
864-486-8433
Provider Enumeration Date:
09/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
954-510-3703

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  42D1099633 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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