Provider Demographics
NPI:1164846010
Name:SOUTHERN DIAGNOSTIC IMAGING, INC.
Entity Type:Organization
Organization Name:SOUTHERN DIAGNOSTIC IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, SDI
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS, RVT, RDMS
Authorized Official - Phone:828-258-1088
Mailing Address - Street 1:10 PARKSIDE PL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1324
Mailing Address - Country:US
Mailing Address - Phone:828-258-1088
Mailing Address - Fax:
Practice Address - Street 1:10 PARKSIDE PL
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-1324
Practice Address - Country:US
Practice Address - Phone:828-258-1088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26939293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8105008Medicaid
NC8105008Medicaid