Provider Demographics
NPI:1578674610
Name:CROSS CREEK IMAGING LLC
Entity Type:Organization
Organization Name:CROSS CREEK IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-321-0006
Mailing Address - Street 1:PO BOX 11984
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24022-1984
Mailing Address - Country:US
Mailing Address - Phone:540-776-8337
Mailing Address - Fax:
Practice Address - Street 1:726 RAMSEY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-4705
Practice Address - Country:US
Practice Address - Phone:910-321-0006
Practice Address - Fax:910-677-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335651Medicare PIN