Healthcare Provider Details

I. General information

NPI: 1144928383
Provider Name (Legal Business Name): HEALTHBRIDGE DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 POWDERSVILLE RD STE F
EASLEY SC
29642-3703
US

IV. Provider business mailing address

838 POWDERSVILLE RD STE F
EASLEY SC
29642-3703
US

V. Phone/Fax

Practice location:
  • Phone: 864-442-3095
  • Fax: 864-880-2783
Mailing address:
  • Phone: 864-442-3095
  • Fax: 864-880-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAVID JEFFERSON BOITER
Title or Position: OWNER
Credential:
Phone: 864-220-2781