Provider Demographics
NPI:1558329060
Name:LEXINGTON OPEN MRI, LLC
Entity Type:Organization
Organization Name:LEXINGTON OPEN MRI, LLC
Other - Org Name:PALMETTO IMAGING IRMO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP FINANCE AND REVENUE CYCLE
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-718-2078
Mailing Address - Street 1:PO BOX 933548
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-3548
Mailing Address - Country:US
Mailing Address - Phone:770-300-0101
Mailing Address - Fax:700-300-0429
Practice Address - Street 1:7182 WOODROW ST STE 101
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2832
Practice Address - Country:US
Practice Address - Phone:803-256-7646
Practice Address - Fax:803-936-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC470000508OtherRAILROAD MEDICARE
SCSL0079Medicaid
SC=========001OtherBCBS
SC=========001OtherTRICARE
SCQ322730002Medicare PIN