Provider Demographics
NPI:1568891364
Name:CAPE FEAR IMAGING, LLC
Entity Type:Organization
Organization Name:CAPE FEAR IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JESSUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-880-9380
Mailing Address - Street 1:470 DEEP WATER DR SE
Mailing Address - Street 2:
Mailing Address - City:BOLIVIA
Mailing Address - State:NC
Mailing Address - Zip Code:28422-8686
Mailing Address - Country:US
Mailing Address - Phone:910-755-3415
Mailing Address - Fax:910-755-3415
Practice Address - Street 1:6361 OCEAN HWY E
Practice Address - Street 2:
Practice Address - City:WINNABOW
Practice Address - State:NC
Practice Address - Zip Code:28479-5758
Practice Address - Country:US
Practice Address - Phone:910-755-3415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207U00000X, 207UN0902X, 2085R0202X, 2085U0001X, 246Z00000X, 247100000X, 2471N0900X, 261QS1200X, 293D00000X, 332B00000X, 335V00000X
NC335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging SupplierGroup - Multi-Specialty