NPIMap

Organization Active NPI

Direct Diagnostic Services, LLC

  • Physiological Laboratory
  • Charleston, SC
National Provider Identifier
1801040274
Registry record updated May 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
DIRECT DIAGNOSTIC SERVICES, LLC
Practice address
4 Carriage LN Ste 108
Charleston, SC 29407-6048
Phone
(828) 396-5634
Fax
(888) 818-8707
NPI assigned
Nov 11, 2008
Last updated
May 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2021

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

Authorized official

Name
Pamela R Queen
Title
Member Manager
Phone
(828) 396-5634

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X
Physiological Laboratory 293D00000X NC Primary

Addresses

Primary practice location

4 Carriage LN Ste 108
Charleston, SC 29407-6048

Mailing address

125 A Wamsutta Mill Road
Morganton, NC 28655-5522
Phone (828) 430-3511

Other practice location 1

125 A Wamsutta Mill Rd.
Morganton, NC 28655-5522
Phone (828) 430-3511 ext. 200

Other practice location 2

1240 Winnowing Way
Suite 102
Mt Pleasant, SC 29466-2946
Phone (828) 430-3511

Other identifiers 2

IdentifierTypeStateIssuer
SL0105MedicaidSC
8105053MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110330000670 SC Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1456417880 Practice locations: Charleston, SC

National Provider Directory

National Provider Directory

Locations

4030 Hickory Blvd
Unit 8
Granite Falls, NC 28630
Phone (828) 396-5634

125 Wamsutta Mill Rd
Ste A
Morganton, NC 28655
Phone (828) 396-5634

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1801040274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 A WAMSUTTA MILL ROAD",
            "city": "MORGANTON",
            "state": "NC",
            "postal_code": "286555522",
            "telephone_number": "828-430-3511",
            "fax_number": "828-430-3513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CARRIAGE LN STE 108",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294076048",
            "telephone_number": "828-396-5634",
            "fax_number": "888-818-8707"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 A Wamsutta Mill Rd.",
            "address_purpose": "LOCATION",
            "city": "Morganton",
            "state": "NC",
            "postal_code": "286555522",
            "country_code": "US",
            "telephone_number": "828-430-3511 x200",
            "fax_number": "828-368-4303",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1240 WINNOWING WAY",
            "address_2": "SUITE 102",
            "address_purpose": "LOCATION",
            "city": "MT PLEASANT",
            "state": "SC",
            "postal_code": "294662946",
            "country_code": "US",
            "telephone_number": "828-430-3511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DIRECT DIAGNOSTIC SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-11",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "QUEEN",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "828-396-5634"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SL0105",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8105053",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; 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.