=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972546133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCK HILL RADIOLOGY ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/14/2006
-----------------------------------------------------
Last Update Date | 08/07/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 218 S HERLONG AVE
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29732-1158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-238-9654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 63308
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28263-3308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-238-9654
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | MARK MATTHEWS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 866-238-9654
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------