Provider Demographics
NPI:1376000109
Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY IMAGING CENTER
Entity type:Organization
Organization Name:MEDICAL UNIVERSITY HOSPITAL AUTHORITY IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KARYN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-876-1344
Mailing Address - Street 1:PO BOX 23319
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3319
Mailing Address - Country:US
Mailing Address - Phone:843-792-2311
Mailing Address - Fax:
Practice Address - Street 1:1037 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2205
Practice Address - Country:US
Practice Address - Phone:803-313-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-28
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty