MECKLENBURG DIAGNOSTIC IMAGING LLC (NPI# 1093773384) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093773384 |
| Entity Type | Organization |
| Organization Name | MECKLENBURG DIAGNOSTIC IMAGING LLC |
| Other Organization Name | NOVANT HEALTH IMAGING SOUTHPARK |
| Practice Address |
6324 Fairview Rd Suite 120 A Charlotte NC 28210-3200 |
| Mailing Address |
Po Box 603543 Charlotte NC 28260-3543 |
| Practice Telephone | 7043628444 |
| Practice Fax Number | 7043623557 |
| Mailing Telephone | 6783935600 |
| Mailing Fax Number | 7703009018 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2017-07-10 |
| Authorized Official Name | MR. DANIEL J SCHAEFER (COO) |
| Authorized Official Telephone | 7703000101 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 6901514 | 05 | |
| SC | SL0083 | 05 | |
| NC | DOL | 153718700 | 01 |
| NC | BCBS NC | 01514 | 01 |
| SC | NPB300 | 05 | |
| MEDICARE RR | P00315955 | 01 |
| Other Name | Type Code |
|---|---|
| Novant Health Imaging Southpark | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770636268 | Mecklenburg Diagnostic Imaging LLC | Radiology | 920 Cox Rd, Bldg C Ste 101, Gastonia, NC 28054-3456 | 2007-01-19 |
| 1215080536 | Mecklenburg Diagnostic Imaging LLC | Radiology | 118 Gateway Blvd Ste E, Mooresville, NC 28117-6542 | 2007-01-19 |
| 1265480446 | Mecklenburg Diagnostic Imaging LLC | Radiology | 3723 Union Rd, Gastonia, NC 28056-8044 | 2006-05-04 |
| 1962450155 | Mecklenburg Diagnostic Imaging LLC | Radiology | 1309 E Sunset Dr, Monroe, NC 28112-4324 | 2006-05-04 |
| Street Address |
6324 FAIRVIEW RD SUITE 120 A |
| City | CHARLOTTE |
| State | NC |
| Zip Code | 28210-3200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750380549 | William E Porter | Obstetrics & Gynecology | 6324 Fairview Rd, Suite 390, Charlotte, NC 28210-3271 | 2005-07-14 |
| 1184163859 | Cary Probst | Physician Assistant | 6324 Fairview Rd, Suite 390, Charlotte, NC 28210-3271 | 2017-02-15 |
| 1457710436 | Novant Medical Group Inc | Psychiatry & Neurology | 6324 Fairview Rd, Suite 350, Charlotte, NC 28210-3271 | 2016-02-18 |
| 1174991871 | Novant Medical Group, Inc | Obstetrics & Gynecology | 6324 Fairview Rd, Suite 390, Charlotte, NC 28210-3271 | 2015-09-11 |
| 1093101222 | Sashalee Stewart | Psychiatry & Neurology | 6324 Fairview Rd, Charlotte, NC 28210-3271 | 2015-04-14 |
| 1801287610 | Amy Petticrew | Physician Assistant | 6324 Fairview Rd, Suite 201, Charlotte, NC 28210-3271 | 2015-02-16 |
| 1790110484 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 6324 Fairview Rd, Charlotte, NC 28210-3271 | 2013-09-12 |
| 1023458767 | Amy Smith Medlin | Social Worker | 6324 Fairview Rd, Suite 350, Charlotte, NC 28210-3271 | 2013-06-26 |
| 1710322367 | Daniel Scott Donner | Pediatrics | 6324 Fairview Rd, Suite 350, Charlotte, NC 28210-3271 | 2013-05-08 |
| 1447414925 | Novant Medical Group, Inc. | Obstetrics & Gynecology | 6324 Fairview Rd, Ste 390, Charlotte, NC 28210-4173 | 2008-07-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952920860 | Rx Care 14 LLC | Pharmacy | 7701 Sharon Lakes Road, Suite H, Charlotte, NC 28210 | 2020-04-10 |
| 1427697622 | David Durant Dinsmore | Nurse Anesthetist, Certified Registered | Atrium Health Pineville, 10628 Park Road, Charlotte, NC 28210 | 2020-01-06 |
| 1790256964 | Tele Phys Inc | Internal Medicine | 10035 Park Center Dr., Ste 100, Charlotte, NC 28210 | 2018-12-16 |
| 1104395896 | Bridgett Williams | Behavior Technician | 7806 Andover Woods Drive, Charlotte, NC 28210 | 2018-11-26 |
| 1053880518 | Low-t Physicians Professional Association | Internal Medicine | 10430 Park Road Suite 100a, Charlotte, NC 28210 | 2018-11-14 |
| 1053895102 | Carolinas Medical Equipment LLC | Durable Medical Equipment & Medical Supplies | 7701 Sharon Lakes Blvd, Ste A., Charlotte, NC 28210 | 2018-09-24 |
| 1679066658 | Afc Urgent Care and Family Care of Wnc, Pllc | Clinic/Center | 10102 Johnston Rd, Charlotte, NC 28210 | 2018-06-13 |
| 1346777018 | Hopeway Foundation | Clinic/Center | 1717 Sharon Road West, Charlotte, NC 28210 | 2017-05-12 |
| 1891154688 | Jessie Lee Ogienko | Social Worker | 5960 Fairview Rd Ste 328, Charlotte, NC 28210 | 2016-02-22 |
| 1699151985 | Carolina Complete Psychiatry, Pllc | Physician Assistant | 5950 Fairview Road, Suite 708, Charlotte, NC 28210 | 2015-08-10 |
| Find all providers in zip 28210 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003110677 | Charlotte Radiology Pa | Radiology | 1025 Morehead Medical Dr Ste 150, Charlotte, NC 28204-2973 | 2010-12-22 |
| 1144477258 | Presbyterian Imaging Centers LLC | Radiology | 13557 Steelecroft Parkway, Suite 1100, Charlotte, NC 28278 | 2008-08-20 |
| 1801097803 | Orion Imaging, LLC | Radiology | 10420 Park Rd, Ste 100, Charlotte, NC 28210-8501 | 2007-05-29 |
| 1457561912 | John D Wylie | Radiology | 3816 Latrobe Dr, Charlotte, NC 28211-1167 | 2007-05-23 |
| 1417029455 | Gregory John Duellman | Radiology | 14121 Lissadell Cir, Charlotte, NC 28277-3137 | 2006-11-14 |
| 1407926165 | Metrolina Women's Breast Center Pllc | Radiology | 439 N Wendover Road, Charlotte, NC 28211 | 2006-11-09 |
| 1932286523 | Charles Nicholas Pappas | Radiology | 609 Stockbridge Rd, Charlotte, VT 05445-9361 | 2006-11-01 |
| 1164439873 | Kenneth Fox | Radiology | 9935d Rea Rd Ste 266, Charlotte, NC 28277-6710 | 2006-08-02 |
| 1265470421 | Kevin W Carroll | Radiology | 3623 Latrobe Drive, Ste 216, Charlotte, NC 28211 | 2006-06-02 |
| 1528032604 | Diane Huntington Conley | Radiology | 3815 Stoney Ridge Trl, Charlotte, NC 28210-6932 | 2006-02-15 |
| Find all providers in CHARLOTTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.