Healthcare Provider Details

I. General information

NPI: 1609718360
Provider Name (Legal Business Name): MEDLINQ DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 SOUTHMOOR LN
FORT MILL SC
29707-9117
US

IV. Provider business mailing address

10011 SOUTHMOOR LN
FORT MILL SC
29707-9117
US

V. Phone/Fax

Practice location:
  • Phone: 800-536-0077
  • Fax: 704-276-6444
Mailing address:
  • Phone: 800-536-0077
  • Fax: 704-276-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SERGIO KHOMYAK
Title or Position: CEO
Credential: RDMS, RVT
Phone: 704-390-6607