Provider Demographics
NPI:1497903298
Name:EAST COAST IMAGING, LLC
Entity Type:Organization
Organization Name:EAST COAST IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:910-522-0470
Mailing Address - Street 1:4443 WACCAMAW SHORES RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450-2401
Mailing Address - Country:US
Mailing Address - Phone:910-840-6766
Mailing Address - Fax:
Practice Address - Street 1:812 CANDY PARK RD
Practice Address - Street 2:SUITE 7101-C
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-9129
Practice Address - Country:US
Practice Address - Phone:910-522-0470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology