Provider Demographics
NPI:1043297088
Name:MOBILE RADIOLOGY & EKG OF CAROLINA, INC.
Entity type:Organization
Organization Name:MOBILE RADIOLOGY & EKG OF CAROLINA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARTWRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-443-0389
Mailing Address - Street 1:PO BOX 17488
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-0488
Mailing Address - Country:US
Mailing Address - Phone:727-443-0389
Mailing Address - Fax:727-442-7851
Practice Address - Street 1:1310 HAVILAND CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4030
Practice Address - Country:US
Practice Address - Phone:803-731-9661
Practice Address - Fax:803-750-9717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPL0020Medicaid