Waccamaw Ultrasound & Diagnostics

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

WACCAMAW ULTRASOUND & DIAGNOSTICS

Practice address

112 E White Oak St
Lake Waccamaw, NC 28450-2128

Phone

(910) 642-9085

NPI assigned

Sep 22, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Anthony Grigsby

Title

President

Phone

(910) 642-9085

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medical Center Diagnostics Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316649600000",
    "number": "1043593395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017507",
            "telephone_number": "910-642-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 E WHITE OAK ST",
            "city": "LAKE WACCAMAW",
            "state": "NC",
            "postal_code": "284502128",
            "telephone_number": "910-642-9085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACCAMAW ULTRASOUND & DIAGNOSTICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-22",
        "last_updated": "2011-09-22",
        "status": "A",
        "authorized_official_last_name": "GRIGSBY",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "910-642-9085"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890129L",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Center Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Lawson Richardson, LCSW
• Thompson Child & Family Focus
• Thompson Child & Family Focus
• Town of Lake Waccamaw
• Stephanie Anne Tucker, LCSWA
• Sarah Thomson Wyche

• All providers in Lake Waccamaw, NC
• Radiology Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.