Organization
EXECUTIVE IMAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA GOOLSBY (OWNER)
(336) 918-6328
Entity
Organization
Contact information
Practice address
7820 N POINT BLVD, SUITE 101, WINSTON SALEM, NC 27106-3299
(336) 245-0647
(336) 245-0649
Mailing address
7820 N POINT BLVD, SUITE 101, WINSTON SALEM, NC 27106-3299
(336) 245-0647
(336) 245-0649
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
600495328
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409805
—
NC
01
—
P00245445
MEDICARE RAILROAD
NC
Enumeration date
10/04/2006
Last updated
01/15/2015
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