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 Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2085B0100X | Radiology | Body Imaging | | SOUTH CAROLINA | No |
| 2 | 2085N0700X | Radiology | Neuroradiology | | SOUTH CAROLINA | No |
| 3 | 2085N0904X | Radiology | Nuclear Radiology | | SOUTH CAROLINA | No |
| 4 | 2085P0229X | Radiology | Pediatric Radiology | | SOUTH CAROLINA | No |
| 5 | 2085R0204X | Radiology | Vascular & Interventional Radiology | | SOUTH CAROLINA | No |
| 6 | 2085R0202X | Radiology | Diagnostic Radiology | | SOUTH CAROLINA | Yes |
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 Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1371 | MEDICARE PIN | SOUTH CAROLINA | |
| 2 | ========= | OTHER | SOUTH CAROLINA | US DEPT OF LABOR |
| 3 | ========= | OTHER | NORTH CAROLINA | BCBS OF NC |
| 4 | ========= | OTHER | SOUTH CAROLINA | TRICARE |
| 5 | PA0748 | MEDICAID | SOUTH CAROLINA | |
| 6 | ========= | OTHER | SOUTH CAROLINA | MEDCOST |
| 7 | CA5357 | OTHER | SOUTH CAROLINA | RAILROAD MEDICARE |
| 8 | ========= | OTHER | SOUTH CAROLINA | FEDERAL BLACK LUNG |
| 9 | ========= | OTHER | SOUTH CAROLINA | BCBS OF SC |
| 10 | 8901567 | MEDICAID | NORTH CAROLINA | |
| 11 | ========= | OTHER | SOUTH CAROLINA | STANDARD TAX ID |
