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General NPI Number Information
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NPI Number | 1205766748
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Entity Type | Organization
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Legal Business Name | DIRECT IMAGING SERVICES LLC
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Dates
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Enumeration Date | 05/19/2026
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Last Update Date | 05/19/2026
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Provider Practice Location Address
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Address Line | 2157 RICH STREET SUITE101
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-6507
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Country | US
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Telephone | 843-414-7026
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Fax |
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Provider Business Mailing Address
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Address Line | 2157 RICH STREET SUITE 101
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-6507
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Country | US
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Telephone | 843-414-7026
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK GROGG
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Credential |
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Telephone | 843-708-3891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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