Provider Demographics
NPI:1275574618
Name:CAROLINA IMAGING CENTER LLC
Entity Type:Organization
Organization Name:CAROLINA IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-226-8889
Mailing Address - Street 1:803 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5707
Mailing Address - Country:US
Mailing Address - Phone:864-226-8889
Mailing Address - Fax:
Practice Address - Street 1:803 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5707
Practice Address - Country:US
Practice Address - Phone:864-226-8889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC247478247100000X
SC0017572471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Not Answered2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2958Medicaid
GA00465913BMedicaid
SC91823OtherMEDCOST ID NUMBER
GA00465913BMedicaid