Healthcare Provider Details

I. General information

NPI: 1154854503
Provider Name (Legal Business Name): MRI SPECIALISTS OF THE CAROLINAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SUMMIT CROSSING PL STE 106
GASTONIA NC
28054-2189
US

IV. Provider business mailing address

620 SUMMIT CROSSING PL STE 106
GASTONIA NC
28054-2189
US

V. Phone/Fax

Practice location:
  • Phone: 704-867-8021
  • Fax: 704-864-4606
Mailing address:
  • Phone: 704-867-8021
  • Fax: 704-864-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number070760
License Number StateNC

VIII. Authorized Official

Name: RICHARD KEENER
Title or Position: CEO
Credential:
Phone: 704-867-8021