NPIMap

Organization Active NPI

Carolina Forest Imaging Center LLC

  • Diagnostic Radiology Physician
  • Myrtle Beach, SC
National Provider Identifier
1942491303
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
CAROLINA FOREST IMAGING CENTER LLC
Practice address
199 Village Center Blvd
Suite 110
Myrtle Beach, SC 29579
Phone
(843) 236-7878
Fax
(843) 236-6406
NPI assigned
Aug 9, 2007
Last updated
Nov 30, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

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

Authorized official

Name
Mr. Lavelle R Hardin
Title
Credentialing Coordinator
Phone
(615) 344-8203

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

199 Village Center Blvd
Suite 110
Myrtle Beach, SC 29579

Mailing address

199 Village Center Blvd
Suite 110
Myrtle Beach, SC 29579
Phone (843) 236-7878

Other identifiers 1

IdentifierTypeStateIssuer
GP4758MedicaidSC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1942491303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "199 VILLAGE CENTER BLVD",
            "address_2": "SUITE 110",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29579",
            "telephone_number": "843-236-7878",
            "fax_number": "843-236-6406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "199 VILLAGE CENTER BLVD",
            "address_2": "SUITE 110",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "29579",
            "telephone_number": "843-236-7878",
            "fax_number": "843-236-6406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA FOREST IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "HARDIN",
        "authorized_official_first_name": "LAVELLE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "615-344-8203",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4758",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.