Provider Demographics
NPI:1790731156
Name:WINYAH DIAGNOSTICS INC
Entity Type:Organization
Organization Name:WINYAH DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-979-9729
Mailing Address - Street 1:PO BOX 4443
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-8443
Mailing Address - Country:US
Mailing Address - Phone:843-979-9729
Mailing Address - Fax:843-979-1366
Practice Address - Street 1:21D PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585
Practice Address - Country:US
Practice Address - Phone:843-979-9729
Practice Address - Fax:843-979-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSL0041Medicaid
SC630001644OtherRAILROAD MEDICARE
SCQ323510001Medicare PIN