NPIMap

Organization Active NPI

Medical Imaging Center, LLC

Doing business as Valley Regional Imaging

  • Physiological Laboratory
  • Fayetteville, NC
National Provider Identifier
1245474022
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
License
LM0075 Issued in NC
Legal business name
MEDICAL IMAGING CENTER, LLC
Doing business as
Valley Regional Imaging
Practice address
3186 Village Dr
Suite 101
Fayetteville, NC 28304-3978
Phone
(910) 323-2209
Fax
(910) 323-9680
NPI assigned
Apr 24, 2009
Last updated
Oct 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Brandi Henry
Title
Executive Directory
Phone
(910) 322-5729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X LM0075 NC Primary

Addresses

Primary practice location

3186 Village Dr
Suite 101
Fayetteville, NC 28304-3978

Mailing address

3186 Village Dr
Suite 101
Fayetteville, NC 28304-3978
Phone (910) 323-2209

Other identifiers 1

IdentifierTypeStateIssuer
5912303MedicaidNC

Other names 1

  • Valley Regional Imaging Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090715000362 NC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1951453307 Practice locations: Fayetteville, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D1092376Cape Fear Valley Outpatient Imaging Center -3186 Village Drive Ste 101, Fayetteville, NC 28304RegistrationSep 24, 2027

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3186 Village Dr
Ste 200
Fayetteville, NC 28304
Phone (910) 323-2209

Practitioners & affiliated clinicians

Practitioners 45

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.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1245474022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3186 VILLAGE DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043978",
            "telephone_number": "910-323-2209",
            "fax_number": "910-323-9680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3186 VILLAGE DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043978",
            "telephone_number": "910-323-2209",
            "fax_number": "910-323-9680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL IMAGING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "BRANDI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTORY",
        "authorized_official_telephone_number": "910-322-5729"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NC",
            "license": "LM0075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5912303",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Regional Imaging",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Regional Imaging",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.