Lake City - Kingstree Radiology, PC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

LAKE CITY - KINGSTREE RADIOLOGY, PC

Practice address

258 N Ron McNair Blvd
Lake City, SC 29560-2462

Phone

(843) 374-6171

Fax

(843) 374-6133

NPI assigned

Jan 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Bert L Booker, MD

Title

President

Phone

(843) 374-6171

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jack Gilbert Brock Jr., M.D.

  • Diagnostic Radiology Physician
  • Charlotte, NC
  • NPI 1285607770
  NPD (past)

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193097600000",
    "number": "1760530208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3328 GUESS RD",
            "address_2": "SUITE 2A",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277052158",
            "telephone_number": "919-620-5700",
            "fax_number": "919-620-3632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "258 N RON MCNAIR BLVD",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295602462",
            "telephone_number": "843-374-6171",
            "fax_number": "843-374-6133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CITY - KINGSTREE RADIOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-10-23",
        "status": "A",
        "authorized_official_last_name": "BOOKER",
        "authorized_official_first_name": "BERT",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-374-6171",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "A4139",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3037",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Horton Kirby, RPH
• KJ 'S Pharmacy,Inc (KJ Pharmacy #129)
• KJ Pharmacy
• KJ Pharmacy Inc
• Regina Knight
• Lake City Adult Day Care, Inc.
• Lake City Community Day Services, Inc.
• Lake City Community Day Services, Inc.
• Lake City Diagnostic Imaging, Inc. (Lake City Diagnostic Imaging)
• Lake City Family Dentistry

• Diagnostic Radiology Physician in Lake City, SC
• Providers in Lake City, 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 Oct 23, 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.