Provider Demographics
NPI:1265469795
Name:DIAGNOSTIC RADIOLOGY & IMAGING, LLC
Entity type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY & IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-433-5010
Mailing Address - Street 1:1150 REVOLUTION MILL DR STE 9
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5086
Mailing Address - Country:US
Mailing Address - Phone:336-280-4003
Mailing Address - Fax:336-303-1696
Practice Address - Street 1:315 W WENDOVER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8401
Practice Address - Country:US
Practice Address - Phone:336-433-5000
Practice Address - Fax:336-433-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790233AMedicaid
NC0233AOtherBCBS OF NC
NC1601436OtherUNITED HEALTHCARE
NCCN4018OtherRAILROAD MEDICARE
NCCN4018OtherRAILROAD MEDICARE