{"npi":"1215080536","type":"NPI-2","status":"active","name":{"display":"Mecklenburg Diagnostic Imaging LLC","other":[],"organization_name":"MECKLENBURG DIAGNOSTIC IMAGING LLC","authorised_official":"Geoffrey Gardner"},"specialty":{"primary_taxonomy":"2085R0202X","primary_taxonomy_description":"Diagnostic Radiology","slug":"diagnostic-radiology","schema_org_specialty":"Radiography","all":[{"code":"2085R0202X","description":"Diagnostic Radiology","primary":true,"state":"NC","license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"118 GATEWAY BLVD STE E","city":"MOORESVILLE","state":"NC","postal_code":"281176542","country_code":"US","phone":"7046628580","fax":"7046628846"},{"purpose":"MAILING","street_1":"PO BOX 603543","city":"CHARLOTTE","state":"NC","postal_code":"282603543","country_code":"US","phone":"6783935600","fax":"7703009018"}],"license":null,"identifiers":[{"type_code":"01","label":"Other","value":"P00315955","state":"NC","issuer":"MEDICARE RAILROAD"},{"type_code":"01","label":"Other","value":"7456027","state":"NC","issuer":"AETNA"},{"type_code":"01","label":"Other","value":"1897409","state":null,"issuer":"UHC"},{"type_code":"01","label":"Other","value":"020FX","state":"NC","issuer":"BCBS"},{"type_code":"01","label":"Other","value":"153718703","state":"NC","issuer":"DOL"},{"type_code":"05","label":"Medicaid","value":"5906448","state":"NC","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20070716000705","type_code":"12-47","type_desc":"PART B SUPPLIER - INDEPENDENT DIAGNOSTIC TESTING FACILITY (IDTF)","state":"NC","pac_id":"3375455991"}]},"enumeration_date":"2007-01-19","last_updated":"2024-03-19","_meta":{"source":"NPPES","snapshot_date":"2024-03-19","doc_url":"https://findmynpi.com/api"}}