=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982983052
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRATEGIC IMAGING CONSULTANTS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2011
-----------------------------------------------------
Last Update Date | 08/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 321 WESTSIDE DR
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27516-8394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-537-8471
-----------------------------------------------------
Fax | 919-537-8478
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 WESTSIDE DR
-----------------------------------------------------
City | CHAPEL HILL
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27516-8394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-537-8471
-----------------------------------------------------
Fax | 919-537-8478
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | JOHN B FEOLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 919-537-8471
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 200100533
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------