Healthcare Provider Details

I. General information

NPI: 1518918481
Provider Name (Legal Business Name): PRESBYTERIAN IMAGING CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MEDICAL PLAZA DR STE 110
CHARLOTTE NC
28262-8797
US

IV. Provider business mailing address

2085 FRONTIS PLAZA BLVD
WINSTON-SALEM NC
27103-5614
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-1580
  • Fax:
Mailing address:
  • Phone: 336-277-7226
  • Fax: 336-277-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FRED M HARGETT
Title or Position: EVP CFO
Credential:
Phone: 704-384-5184