Provider Demographics
NPI:1396847190
Name:DURHAM DIAGNOSTIC IMAGING LLC
Entity Type:Organization
Organization Name:DURHAM DIAGNOSTIC IMAGING LLC
Other - Org Name:DURHAM DIAGNOSTIC IMAGING-HENDERSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
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 933393
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-0001
Mailing Address - Country:US
Mailing Address - Phone:336-659-1211
Mailing Address - Fax:
Practice Address - Street 1:857 S BECKFORD DR
Practice Address - Street 2:SUITE E
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-3486
Practice Address - Country:US
Practice Address - Phone:252-430-6500
Practice Address - Fax:919-321-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2012-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2670302OtherUHC
NC5950088Medicaid
NC205314603OtherDOL
7378918OtherAETNA
NC020FUOtherBCBS
P00014222OtherMEDICARE RR
NC5950088Medicaid
NC5950088Medicaid