1053386219 NPI number — OUTPATIENT IMAGING, LLC

Table of content: (NPI 1053386219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053386219 NPI number — OUTPATIENT IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTPATIENT IMAGING, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053386219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 639218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-9218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-305-4674
Provider Business Mailing Address Fax Number:
770-305-4682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 EASTBROOK BND
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEACHTREE CITY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30269-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-301-4674
Provider Business Practice Location Address Fax Number:
770-305-4682
Provider Enumeration Date:
02/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
HO
Authorized Official Middle Name:
NIEN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-305-4674

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)