Basic Information
| Provider Information | |||||||||
| NPI: | 1487676425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RALEIGH NEUROLOGY IMAGING PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1540 SUNDAY DR | ||||||||
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| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276076000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197823456 | ||||||||
| FaxNumber: | 9197831441 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 SUNDAY DR | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276075253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197823456 | ||||||||
| FaxNumber: | 9197831441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | FERRELL | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9197823456 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 017GJ | 01 | NC | BLUE CROSS BLUE SHIELD NO | OTHER |