Healthcare Provider Details

I. General information

NPI: 1851934186
Provider Name (Legal Business Name): IMAGECARE RADIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 RABON RD STE 100
COLUMBIA SC
29203-8903
US

IV. Provider business mailing address

710 RABON RD STE 100
COLUMBIA SC
29203-8903
US

V. Phone/Fax

Practice location:
  • Phone: 803-462-3680
  • Fax: 803-462-3690
Mailing address:
  • Phone: 803-462-3680
  • Fax: 803-462-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA BRANTLEY
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 803-462-3680