Healthcare Provider Details

I. General information

NPI: 1710948047
Provider Name (Legal Business Name): LAUREL IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 LAUREL ST SUITE 104
COLUMBIA SC
29204-2038
US

IV. Provider business mailing address

2750 LAUREL ST SUITE 104
COLUMBIA SC
29204-2038
US

V. Phone/Fax

Practice location:
  • Phone: 803-799-9035
  • Fax: 803-799-9710
Mailing address:
  • Phone: 803-799-9035
  • Fax: 803-799-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VAUGHN R BARNICK
Title or Position: PRESIDENT
Credential: MD
Phone: 803-252-1953