MEDICARE: PRESBYTERIAN IMAGING CENTERS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	261QR0200X	Radiology Clinic/Center
2	293D00000X	Physiological Laboratory	NC
3	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00471056	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1602272	OTHER		UHC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	615320702	OTHER	NC	NC DOL

General Provider Information

NPI Number	:	1194776765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESBYTERIAN IMAGING CENTERS LLC

Provider Business Mailing Address
First Line	:	PO BOX 603543
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-3543
Country	:	US
Telephone Number	:	678-393-5600
Fax Number	:	770-300-9018

Provider Business Practice Location Address
First Line	:	14215 BALLANTYNE CORPORATE PLACE
Second Line	:	STE 140
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-3146
Country	:	US
Telephone Number	:	704-384-1890
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	GEOFFREY K. GARDNER
Credential	:
Telephone Number	:	678-992-7255

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	03/19/2024

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Directions to “PRESBYTERIAN IMAGING CENTERS LLC ” Practice Location

Language	Start Address	Practice Location

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