Provider Demographics
NPI:1346470747
Name:SOUTH CAROLINA DIAGNOSTIC IMAGING, INC
Entity Type:Organization
Organization Name:SOUTH CAROLINA DIAGNOSTIC IMAGING, INC
Other - Org Name:INNERVISION MEDICAL IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
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 933548
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3548
Mailing Address - Country:US
Mailing Address - Phone:877-527-9375
Mailing Address - Fax:770-300-9018
Practice Address - Street 1:1 MARCUS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4818
Practice Address - Country:US
Practice Address - Phone:864-751-2051
Practice Address - Fax:864-751-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC470001385OtherRAILROAD MEDICARE
SCQ327980004Medicare PIN