Provider Demographics
NPI:1528244225
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:AVP REGIONAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-540-4322
Mailing Address - Street 1:1317 N ELM STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1023
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1635 HWY 66 SOUTH
Practice Address - Street 2:SUITE 110
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3705
Practice Address - Country:US
Practice Address - Phone:336-993-5328
Practice Address - Fax:336-993-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950051Medicaid
NC2323200Medicare PIN