Healthcare Provider Details

I. General information

NPI: 1205766748
Provider Name (Legal Business Name): DIRECT IMAGING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 RICH STREET SUITE101
NORTH CHARLESTON SC
29405-6507
US

IV. Provider business mailing address

2157 RICH ST UNIT 101
NORTH CHARLESTON SC
29405-6507
US

V. Phone/Fax

Practice location:
  • Phone: 843-414-7026
  • Fax:
Mailing address:
  • Phone: 843-414-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARK GROGG
Title or Position: OWNER
Credential:
Phone: 843-708-3891