Provider Demographics
NPI:1689854812
Name:VALLEY RADIOLOGY AT ANGIER LLC
Entity Type:Organization
Organization Name:VALLEY RADIOLOGY AT ANGIER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAX
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAYKUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-486-5700
Mailing Address - Street 1:169 RAWLS RD.
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501
Mailing Address - Country:US
Mailing Address - Phone:919-331-2001
Mailing Address - Fax:919-331-2003
Practice Address - Street 1:169 RAWLS RD.
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501
Practice Address - Country:US
Practice Address - Phone:919-331-2001
Practice Address - Fax:919-331-2003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQPA797OtherSC MEDICAID
NC204310OtherMEDICARE
NC1630307OtherPHP
NC8901572Medicaid
01572OtherBCBS