Provider Demographics
NPI:1407026545
Name:ANDERSON DIAGNOSTIC IMAGING, INC
Entity Type:Organization
Organization Name:ANDERSON DIAGNOSTIC IMAGING, INC
Other - Org Name:CLEMSON IMAGING
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 1:1011 ELLA ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4807
Mailing Address - Country:US
Mailing Address - Phone:770-300-0101
Mailing Address - Fax:770-300-0429
Practice Address - Street 1:1011 TIGER BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1497
Practice Address - Country:US
Practice Address - Phone:770-300-0101
Practice Address - Fax:770-300-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7978Medicare PIN