Organization
MECKLENBURG DIAGNOSTIC IMAGING LLC
Active
Other names
Novant Health Imaging Mooresville
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY K. GARDNER (SVP FINANCE AND REVENUE CYCLE)
(336) 718-2078
Entity
Organization
Contact information
Practice address
118 GATEWAY BLVD STE E, MOORESVILLE, NC 28117-6542
(704) 662-8580
(704) 662-8846
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
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020FX
BCBS
NC
01
—
153718703
DOL
NC
01
—
1897409
UHC
—
05
—
5906448
—
NC
01
—
7456027
AETNA
NC
01
—
P00315955
MEDICARE RAILROAD
NC
Enumeration date
01/19/2007
Last updated
03/19/2024
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