Organization
DOCTORS HOSPITAL NORTH AUGUSTA IMAGING CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAVELLE R HARDIN (MANAGED CARE ANALYST)
(615) 344-8203
Entity
Organization
Contact information
Practice address
105 HUGH STREET, SUITE A, NORTH AUGUSTA, SC 29841
(803) 426-2000
(803) 426-2041
Mailing address
105 HUGH STREET, SUITE A, NORTH AUGUSTA, SC 29841
(803) 426-2000
(803) 426-2041
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GP4939
BCBS OF SC
SC
05
—
GP4939
—
SC
01
—
P00689930
RR MEDICARE
SC
Enumeration date
07/22/2008
Last updated
06/24/2009
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