Provider Demographics
NPI:1780637751
Name:NORTH CAROLINA DIGITAL IMAGING, INC
Entity Type:Organization
Organization Name:NORTH CAROLINA DIGITAL IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DURWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:336-245-2670
Mailing Address - Street 1:1317 ASHLEYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2918
Mailing Address - Country:US
Mailing Address - Phone:336-245-2670
Mailing Address - Fax:336-245-2017
Practice Address - Street 1:1317 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2918
Practice Address - Country:US
Practice Address - Phone:336-245-2670
Practice Address - Fax:336-245-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC805979OtherPARTNERS MEDICARE CHOICE
NC016XFOtherBLUE CROSS AND BLUE SHIEL
NCP00193196OtherRAILROAD MEDICARE
NC3409804Medicaid
NC2530358Medicare ID - Type Unspecified