Provider Demographics
NPI:1164591756
Name:ADVANCED DIAGNOSTIC IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED DIAGNOSTIC IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-534-0053
Mailing Address - Street 1:PO BOX 2729
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-2729
Mailing Address - Country:US
Mailing Address - Phone:803-534-0053
Mailing Address - Fax:803-534-0291
Practice Address - Street 1:1728 VILLAGE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2426
Practice Address - Country:US
Practice Address - Phone:803-534-0053
Practice Address - Fax:803-534-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADF8754OtherRR MEDICARE
GADF8754OtherRR MEDICARE