Provider Demographics
NPI:1922162270
Name:INNERVISION INC
Entity Type:Organization
Organization Name:INNERVISION INC
Other - Org Name:INNERVISION MEDICAL IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-289-9977
Mailing Address - Street 1:1 MARCUS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4818
Mailing Address - Country:US
Mailing Address - Phone:864-289-9977
Mailing Address - Fax:864-751-2050
Practice Address - Street 1:1 MARCUS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4818
Practice Address - Country:US
Practice Address - Phone:864-289-9977
Practice Address - Fax:864-751-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC240062471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7662Medicare PIN
SCH15761Medicare UPIN