=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417298134
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLUMBUS REGIONAL DIAGNOSTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2013
-----------------------------------------------------
Last Update Date | 01/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 619 JEFFERSON ST. STE. 2
-----------------------------------------------------
City | WHITEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28472-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-642-8011
-----------------------------------------------------
Fax | 910-642-9305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 JEFFERSON ST
-----------------------------------------------------
City | WHITEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28472-3634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-642-8011
-----------------------------------------------------
Fax | 910-642-9305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MARVIN JEFFREY ARMSTRONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-642-1703
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------