Provider Demographics
NPI:1639335797
Name:CAPE FEAR DIAGNOSTIC IMAGING, LLC
Entity Type:Organization
Organization Name:CAPE FEAR DIAGNOSTIC IMAGING, LLC
Other - Org Name:NORTH CAROLINA DIAGNOSTIC IMAGING-WATERFORD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-300-0101
Mailing Address - Street 1:PO BOX 933393
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-0001
Mailing Address - Country:US
Mailing Address - Phone:336-659-1211
Mailing Address - Fax:336-774-1751
Practice Address - Street 1:509 OLDE WATERFORD WAY
Practice Address - Street 2:SUITE 104
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4125
Practice Address - Country:US
Practice Address - Phone:910-383-6047
Practice Address - Fax:910-383-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC020XHOtherBCBS
NC5950412Medicaid
NC011VWOtherBCBS
NC020XHOtherBCBS
NC2881726AMedicare PIN