Provider Demographics
NPI:1003030131
Name:SUPERIOR DIAGNOSTIC IMAGING INC
Entity Type:Organization
Organization Name:SUPERIOR DIAGNOSTIC IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BADDOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-794-6884
Mailing Address - Street 1:PO BOX 16133
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28408-6133
Mailing Address - Country:US
Mailing Address - Phone:910-395-5569
Mailing Address - Fax:910-395-6969
Practice Address - Street 1:11550 COMMON OAKS DR
Practice Address - Street 2:SUITE 110
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-7298
Practice Address - Country:US
Practice Address - Phone:910-395-5569
Practice Address - Fax:910-395-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty