Healthcare Provider Details

I. General information

NPI: 1366826299
Provider Name (Legal Business Name): FLEXOGENIX NORTH CAROLINA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6836 MORRISON BLVD SUITE 101
CHARLOTTE NC
28211-2612
US

IV. Provider business mailing address

1000 S HOPE ST STE 101
LOS ANGELES CA
90015-4057
US

V. Phone/Fax

Practice location:
  • Phone: 800-587-3436
  • Fax:
Mailing address:
  • Phone: 213-622-6010
  • Fax: 213-662-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN P WHALEN
Title or Position: PRESIDENT
Credential: MD
Phone: 213-622-6010