Provider Demographics
NPI:1184740680
Name:INMED DIAGNOSTICS SERVICES OF SC LLC
Entity type:Organization
Organization Name:INMED DIAGNOSTICS SERVICES OF SC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-510-3704
Mailing Address - Street 1:2400 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 826
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4054
Mailing Address - Country:US
Mailing Address - Phone:954-510-3700
Mailing Address - Fax:954-510-2649
Practice Address - Street 1:4701 OLEANDER DR
Practice Address - Street 2:STE C
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5762
Practice Address - Country:US
Practice Address - Phone:843-692-0040
Practice Address - Fax:843-692-0046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85342261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0068Medicaid
SCQ318870006Medicare PIN