Provider Demographics
NPI:1821028986
Name:GEODAX IMAGING, LLC
Entity Type:Organization
Organization Name:GEODAX IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-274-2844
Mailing Address - Street 1:301 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-2101
Mailing Address - Country:US
Mailing Address - Phone:336-274-2844
Mailing Address - Fax:336-274-2817
Practice Address - Street 1:301 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2101
Practice Address - Country:US
Practice Address - Phone:336-274-2844
Practice Address - Fax:336-274-2817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2881714Medicare ID - Type Unspecified