Provider Demographics
NPI:1003864299
Name:CAROLINAS DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:CAROLINAS DIAGNOSTIC IMAGING LLC
Other - Org Name:NOVANT HEALTH IMAGING ROCK HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-300-0101
Mailing Address - Street 1:PO BOX 603543
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3543
Mailing Address - Country:US
Mailing Address - Phone:678-393-5600
Mailing Address - Fax:770-300-9018
Practice Address - Street 1:175 AMENDMENT AVE STE 101
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3042
Practice Address - Country:US
Practice Address - Phone:803-547-1100
Practice Address - Fax:803-547-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC155477800OtherDOL
470001399OtherMEDICARE RAILROAD
NC5902840Medicaid
SCSL0048Medicaid
SCGP5098Medicaid
470001399OtherMEDICARE RAILROAD
SCSL0048Medicaid