Organization
PRESBYTERIAN IMAGING CENTERS LLC
Active
Other names
Novant Health Imaging Ballantyne
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY K. GARDNER (CREDENTIALING)
(678) 992-7255
Entity
Organization
Contact information
Practice address
14215 BALLANTYNE CORPORATE PLACE, STE 140, CHARLOTTE, NC 28277-3146
(704) 384-1890
Mailing address
PO BOX 603543, CHARLOTTE, NC 28260-3543
(678) 393-5600
(770) 300-9018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261QR0200X
Radiology Clinic/Center
—
—
293D00000X
Physiological Laboratory
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1602272
UHC
—
05
—
5917811
—
NC
01
—
615320702
NC DOL
NC
01
—
P00471056
RAILROAD MEDICARE
—
Enumeration date
05/16/2006
Last updated
03/19/2024
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