Healthcare Provider Details

I. General information

NPI: 1376000109
Provider Name (Legal Business Name): MEDICAL UNIVERSITY HOSPITAL AUTHORITY IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 W MEETING ST
LANCASTER SC
29720-2205
US

IV. Provider business mailing address

PO BOX 23319
NEW YORK NY
10087-3319
US

V. Phone/Fax

Practice location:
  • Phone: 803-313-3170
  • Fax:
Mailing address:
  • Phone: 843-792-2311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State

VIII. Authorized Official

Name: KARYN RAE
Title or Position: DIRECTOR
Credential:
Phone: 843-876-1344