Healthcare Provider Details

I. General information

NPI: 1558691477
Provider Name (Legal Business Name): OUTPATIENT IMAGING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SAINT JOSEPHS CANDLER DR
POOLER GA
31322-9584
US

IV. Provider business mailing address

345 COMMERCIAL DR
SAVANNAH GA
31406-3606
US

V. Phone/Fax

Practice location:
  • Phone: 912-356-9222
  • Fax: 912-356-1080
Mailing address:
  • Phone: 912-356-9222
  • Fax: 912-356-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number035851
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number035851
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number035851
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number035851
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number035851
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number035851
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number035851
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number035851
License Number StateGA
# 9
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number035851
License Number StateGA

VIII. Authorized Official

Name: CARLOS A RIVERA
Title or Position: PRESIDENT
Credential:
Phone: 912-352-2606