MEDICARE: DIRECT IMAGING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1205766748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT IMAGING SERVICES LLC

Provider Business Mailing Address
First Line	:	2157 RICH STREET
Second Line	:	SUITE 101
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-6507
Country	:	US
Telephone Number	:	843-414-7026
Fax Number	:

Provider Business Practice Location Address
First Line	:	2157 RICH STREET
Second Line	:	SUITE101
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-6507
Country	:	US
Telephone Number	:	843-414-7026
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARK GROGG
Credential	:
Telephone Number	:	843-708-3891

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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