Provider Demographics
NPI:1407003510
Name:PRESBYTERIAN IMAGING CENTERS LLC
Entity Type:Organization
Organization Name:PRESBYTERIAN IMAGING CENTERS LLC
Other - Org Name:PRESBYTERIAN DIAGNOSTIC CENTER - MONROE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP CFO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-5184
Mailing Address - Street 1:PO BOX 60598
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0598
Mailing Address - Country:US
Mailing Address - Phone:866-659-1211
Mailing Address - Fax:336-774-1751
Practice Address - Street 1:2000 WELLNESS BOULEVARD
Practice Address - Street 2:STE 110
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-7764
Practice Address - Country:US
Practice Address - Phone:704-316-1180
Practice Address - Fax:704-316-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00187889OtherRR MEDICARE
2881790EOtherPTAN
NCNPB425OtherSC MEDICAID
NC5917804Medicaid
NC615320700OtherDOL
NC016M6OtherBCBS
NCNPB425OtherSC MEDICAID
2881790EOtherPTAN