Provider Demographics
NPI:1265425524
Name:METROLINA NEURODIAGNOSTIC CENTER, LLC
Entity type:Organization
Organization Name:METROLINA NEURODIAGNOSTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-366-6135
Mailing Address - Street 1:127 PROFESSIONAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1178
Mailing Address - Country:US
Mailing Address - Phone:803-329-8635
Mailing Address - Fax:803-329-8645
Practice Address - Street 1:127 PROFESSIONAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1178
Practice Address - Country:US
Practice Address - Phone:803-329-8635
Practice Address - Fax:803-329-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3790Medicaid
NC89015KFMedicaid
SCGP3790Medicaid