Provider Demographics
NPI:1467068833
Name:SOUTHERN PINES DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:SOUTHERN PINES DIAGNOSTIC IMAGING, LLC
Other - Org Name:FIRSTHEALTH IMAGING - SOUTHERN PINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-1000
Mailing Address - Street 1:355 S BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5403
Mailing Address - Country:US
Mailing Address - Phone:910-692-7449
Mailing Address - Fax:910-639-3759
Practice Address - Street 1:355 S BENNETT ST
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5403
Practice Address - Country:US
Practice Address - Phone:910-692-7449
Practice Address - Fax:910-639-3759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty