Healthcare Provider Details

I. General information

NPI: 1265425524
Provider Name (Legal Business Name): METROLINA NEURODIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PROFESSIONAL PARK BLVD
ROCK HILL SC
29732-1178
US

IV. Provider business mailing address

127 PROFESSIONAL PARK BLVD
ROCK HILL SC
29732-1178
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-8635
  • Fax: 803-329-8645
Mailing address:
  • Phone: 803-329-8635
  • Fax: 803-329-8645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD MANDELL
Title or Position: PARTNER
Credential: M.D.
Phone: 803-366-6135