Healthcare Provider Details

I. General information

NPI: 1508807249
Provider Name (Legal Business Name): REIDSVILLE IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 RICHARDSON DR SUITE A
REIDSVILLE NC
27320-5901
US

IV. Provider business mailing address

PO BOX 16983
CHAPEL HILL NC
27516-6983
US

V. Phone/Fax

Practice location:
  • Phone: 336-349-5899
  • Fax: 336-349-5995
Mailing address:
  • Phone: 919-967-6646
  • Fax: 919-967-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND EVELAND
Title or Position: MEMBER
Credential:
Phone: 336-202-5593