Southern Pines Diagnostic Imaging, LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

SOUTHERN PINES DIAGNOSTIC IMAGING, LLC

Doing business as

FirstHealth Imaging - Southern Pines

Practice address

355 S Bennett St
Southern Pines, NC 28387-5403

Phone

(910) 692-7449

Fax

(910) 692-7581

NPI assigned

Sep 21, 2020

Last updated

Dec 31, 2024By 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

Mickey Foster

Title

Ceo

Phone

(910) 715-4473

Specialties & licenses 2

Addresses

Other names 1

• FirstHealth Imaging - Southern Pines Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Member of 1

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

• Firsthealth of the Carolinas, Inc

  dba FirstHealth Home Care

  • Home Health Agency
  • West End, NC
  • NPI 1770574766

  Member Of

  NPD member

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.

• John P Roberson, MD

  • Diagnostic Radiology Physician
  • Pinehurst, NC
  • NPI 1285681106
  NPD
• David Royal Warden IV, M.D.

  • Diagnostic Radiology Physician
  • Pinehurst, NC
  • NPI 1801213129
  NPD

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735603200000",
    "number": "1467068833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 S BENNETT ST",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283875403",
            "telephone_number": "910-692-7449",
            "fax_number": "910-692-7581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 S BENNETT ST",
            "city": "SOUTHERN PINES",
            "state": "NC",
            "postal_code": "283875403",
            "telephone_number": "910-692-7449",
            "fax_number": "910-692-7581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES DIAGNOSTIC IMAGING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-21",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A",
        "authorized_official_last_name": "FOSTER",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "910-715-4473"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FirstHealth Imaging - Southern Pines",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FirstHealth Imaging - Southern Pines",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tammie Bondurant Smith, COTA
• Tiara Smith
• Megan Soros
• Jena Leigh Southerland, MS CCC-SLP
• Southern Pines Chiropractic, P.a.
• Southern Pines Physical Therapy, LLC
• Southern Pines Prescription Shop Inc (McClain Drug)
• Southern Pines Surgery Center, LLC
• Southern Pines Women's Health Center PC
• Southern Speech Diagnostics PLLC

• Physiological Laboratory in Southern Pines, NC
• Providers in Southern Pines, NC by specialty
• Physiological Laboratory in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.