1831269687 NPI number — CAROLINA RADIOLOGY, PA

Table of content: (NPI 1831269687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831269687 NPI number — CAROLINA RADIOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA RADIOLOGY, PA
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:
1831269687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24034-3445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-788-9852
Provider Business Mailing Address Fax Number:
540-776-6856

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:
910-794-6884
Provider Business Practice Location Address Fax Number:
910-395-6714
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THARRINGTON
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
910-794-6884

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  9400160 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890237C , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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