Provider Demographics
NPI:1710948047
Name:LAUREL IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:LAUREL IMAGING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BARNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-252-1953
Mailing Address - Street 1:2750 LAUREL ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2038
Mailing Address - Country:US
Mailing Address - Phone:803-799-9035
Mailing Address - Fax:803-799-9710
Practice Address - Street 1:2750 LAUREL ST
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2038
Practice Address - Country:US
Practice Address - Phone:803-799-9035
Practice Address - Fax:803-799-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology