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General NPI Number Information
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NPI Number | 1801040274
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Entity Type | Organization
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Legal Business Name | DIRECT DIAGNOSTIC SERVICES, LLC
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 4 CARRIAGE LN STE 108
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City | CHARLESTON
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State | SC
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Zip | 29407-6048
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Country | US
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Telephone | 828-396-5634
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Fax | 888-818-8707
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Provider Business Mailing Address
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Address Line | 125 A WAMSUTTA MILL ROAD
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City | MORGANTON
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State | NC
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Zip | 28655-5522
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Country | US
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Telephone | 828-430-3511
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Fax | 828-430-3513
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | PAMELA R QUEEN
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Credential |
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Telephone | 828-396-5634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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 | NC
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