Provider Demographics
NPI:1831228097
Name:CAROLINA DIAGNOSTIC SERVICES
Entity type:Organization
Organization Name:CAROLINA DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-269-3867
Mailing Address - Street 1:PO BOX 792
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0792
Mailing Address - Country:US
Mailing Address - Phone:864-269-3867
Mailing Address - Fax:
Practice Address - Street 1:3320 HIGHWAY 153
Practice Address - Street 2:STE B
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6713
Practice Address - Country:US
Practice Address - Phone:864-269-3867
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ266980001Medicare ID - Type UnspecifiedPROVIDER NUMBER