Organization
OUTPATIENT IMAGING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS A RIVERA (PRESIDENT)
(912) 352-2606
Entity
Organization
Contact information
Practice address
101 SAINT JOSEPHS CANDLER DR, POOLER, GA 31322-9584
(912) 356-9222
(912) 356-1080
Mailing address
345 COMMERCIAL DR, SAVANNAH, GA 31406-3606
(912) 356-9222
(912) 356-1080
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
035851
GA
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
035851
GA
2085N0700X
Neuroradiology Physician
035851
GA
2085N0904X
Nuclear Radiology Physician
035851
GA
2085P0229X
Pediatric Radiology Physician
035851
GA
2085R0202X
Diagnostic Radiology Physician
Primary
035851
GA
2085R0203X
Therapeutic Radiology Physician
035851
GA
2085R0204X
Vascular & Interventional Radiology Physician
035851
GA
2085U0001X
Diagnostic Ultrasound Physician
035851
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
595704108
—
GA
01
—
DQ2575
RR MEDICARE
GA
Enumeration date
12/29/2009
Last updated
10/23/2023
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