Organization
CAROLINA RADIATION MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GORDON GARY KOLTIS MD (PRESIDENT)
(252) 329-0025
Entity
Organization
Contact information
Practice address
801 W H SMITH BLVD, GREENVILLE, NC 27834-3764
(252) 329-0025
(252) 329-0325
Mailing address
801 W H SMITH BLVD, GREENVILLE, NC 27834-3764
(252) 329-0025
(252) 329-0325
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010SK
BCBS
NC
01
—
118170
TRICARE
NC
01
—
24-00059
UNITED HEALTHCARE
NC
05
—
89010SK
—
NC
Enumeration date
06/08/2005
Last updated
07/18/2008
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