Provider Demographics
NPI:1114684941
Name:COLUMBUS REGIONAL DIAGNOSTICS
Entity Type:Organization
Organization Name:COLUMBUS REGIONAL DIAGNOSTICS
Other - Org Name:ADVANCED IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:GORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:191-064-0406
Mailing Address - Street 1:500 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3634
Mailing Address - Country:US
Mailing Address - Phone:910-640-4060
Mailing Address - Fax:910-642-9328
Practice Address - Street 1:509 OLDE WATERFORDWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451
Practice Address - Country:US
Practice Address - Phone:910-640-4380
Practice Address - Fax:910-399-4353
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLUMBUS REGIONAL DIAGNOSTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-29
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory