Southeast Regional Virtual Imaging Consulting Enterprise PA

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

16566 Issued in SC

Legal business name

SOUTHEAST REGIONAL VIRTUAL IMAGING CONSULTING ENTERPRISE PA

Practice address

225 Stable Gate Dr
Campobello, SC 29322-8037

Phone

(864) 468-5570

Fax

(864) 468-5239

NPI assigned

Aug 3, 2006

Last updated

Dec 21, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Stephen Jacob Gordin, M.D.NPI 1386668879

Title

President

Phone

(864) 468-5238

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen Jacob Gordin, MD

  • Diagnostic Radiology Physician
  • Campobello, SC
  • NPI 1386668879
  NPD (past) Authorized official
• Deborah Ann Dipersio, MD

  • Diagnostic Radiology Physician
  • Wilmington, NC
  • NPI 1972504272
  NPD (past)

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198195200000",
    "number": "1205844586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52990",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296490048",
            "telephone_number": "864-223-3600",
            "fax_number": "864-223-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 STABLE GATE DR",
            "city": "CAMPOBELLO",
            "state": "SC",
            "postal_code": "293228037",
            "telephone_number": "864-468-5570",
            "fax_number": "864-468-5239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST REGIONAL VIRTUAL IMAGING CONSULTING ENTERPRISE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-12-21",
        "status": "A",
        "authorized_official_last_name": "GORDIN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "864-468-5238",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "16566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4506",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Arlene Marin
• Karen Beth McCreary
• Renew Health & Wellness, LLC
• Leslie Allison Shields, DPT
• Caroline Skellie, RDH
• Spartanburg County District One Schools
• Spartanburg School District One
• Katherine Vickery, MS, CCC/SLP
• Kenna Riley Watson

• Diagnostic Radiology Physician in Campobello, SC
• Providers in Campobello, SC by specialty
• Diagnostic Radiology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2007; 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.