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EXECUTIVE IMAGE INC NPI 1588759849


NPI Information

NPI: 1588759849
Provider Name: EXECUTIVE IMAGE INC
Classification: Portable X-ray and/or Other Portable Diagnostic Imaging Supplier - 335V00000X
Entity Type: Organization
Address:
7820 N POINT BLVD
SUITE 101
WINSTON SALEM, NC
ZIP 27106
Phone: (336) 245-0647
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EXECUTIVE IMAGE INC is a portable x ray and or other portable diagnostic imaging supplier in Winston Salem, NC. The provider is a supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed. EXECUTIVE IMAGE INC NPI is 1588759849. The provider is registered as an organization entity type.

The provider's business location address is:

7820 N POINT BLVD
SUITE 101
WINSTON SALEM, NC
ZIP 27106-299
Phone: (336) 245-0647
Fax: (336) 245-0649

The provider's authorized official is Diana Goolsby .
The authorized official title is Owner and has the following contact phone number (336) 918-6328.

The enumeration date for this NPI number is 10/4/2006 and was last updated on 1/15/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1335V00000XPortable X-ray and/or Other Portable Diagnostic Imaging Supplier600495328NORTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
13409805MEDICAIDNORTH CAROLINA
22530321MEDICARE ID-TYPE UNSPECIFIEDNORTH CAROLINAMEDICARE
3=========OTHERNORTH CAROLINABCBS
4P00245445OTHERNORTH CAROLINAMEDICARE RAILROAD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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