Healthcare Provider Details

I. General information

NPI: 1922162270
Provider Name (Legal Business Name): INNERVISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MARCUS DR SUITE 101
GREENVILLE SC
29615-4818
US

IV. Provider business mailing address

1 MARCUS DR SUITE 101
GREENVILLE SC
29615-4818
US

V. Phone/Fax

Practice location:
  • Phone: 864-289-9977
  • Fax: 864-751-2050
Mailing address:
  • Phone: 864-289-9977
  • Fax: 864-751-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number24006
License Number StateSC

VIII. Authorized Official

Name: MRS. KATHY DEPEW
Title or Position: MANAGER
Credential:
Phone: 864-289-9977