MEDICARE: LAUREL IMAGING CENTER, 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	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1710948047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREL IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 104
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-799-9035
Fax Number	:	803-799-9710

Provider Business Practice Location Address
First Line	:	2750 LAUREL ST
Second Line	:	SUITE 104
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-799-9035
Fax Number	:	803-799-9710

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VAUGHN R BARNICK
Credential	:	MD
Telephone Number	:	803-252-1953

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	08/22/2020

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