Provider Demographics
NPI:1689669046
Name:INSIGHT IMAGING LLC
Entity Type:Organization
Organization Name:INSIGHT IMAGING LLC
Other - Org Name:VIDERE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOUKNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-525-7005
Mailing Address - Street 1:9930 KINCEY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-6541
Mailing Address - Country:US
Mailing Address - Phone:704-525-7005
Mailing Address - Fax:704-525-6250
Practice Address - Street 1:9930 KINCEY AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-6541
Practice Address - Country:US
Practice Address - Phone:704-525-7005
Practice Address - Fax:704-525-6250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2881776OtherCIGNA
TNP00228084OtherRR MEDICARE
GAP00345675OtherRR MEDICARE
GA47BBBJFOtherCAHABA
NCP00008129OtherRR MEDICARE
SCQ335650001OtherPALMETTO GBA
SCQ335650001OtherPALMETTO GBA