Executive Image, Inc.

LBN: Executive Image, Inc.
Executive Image, Inc. is an health care organization with primary practice located at 470 W Hanes Mill Rd Suite 107, Winston Salem NC 27105-9102. The organization recently has only one registered license in Laboratories / Physiological Laboratory, which is considered as the primary health care specialty. Executive Image, Inc. can be contacted via phone (336) 918-6328, or through Goolsby, Diana B via phone (336) 918-6328.

Contact Information

Primary practice address
470 W Hanes Mill Rd Suite 107 Winston Salem NC 27105-9102
Phone: (336) 918-6328
Fax: (800) 840-4241
Website:
Map and Directions
Authorized official contact:
Name: Goolsby, Diana B
Phone: (336) 918-6328

Health care specialties

SpecialtyCodeLicense #State
Laboratories / Physiological Laboratory 293D00000X

Profile Details

NPI number 1326437989
LBN Legal business name Executive Image, Inc.
DBA Doing business as
Authorized official Goolsby, Diana B
Entity Organization
Organization subpart 1 No
Enumeration date Jan 20th, 2015
Last updated Jan 20th, 2015 - about 9 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326437989 NPPES
North Carolina MEDICAID 3409805
North Carolina Other 2530321

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