1154319259 NPI number — MEDICAL IMAGING NETWORK INC

Table of content: (NPI 1154319259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154319259 NPI number — MEDICAL IMAGING NETWORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL IMAGING NETWORK INC
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:
ADVANCED RADIOLOGY
Provider Other Organization Name Type Code:
3
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:
1154319259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 MCKAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOARDMAN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44512-5713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-726-9006
Provider Business Mailing Address Fax Number:
330-726-2068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 E MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44484-2214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-856-9729
Provider Business Practice Location Address Fax Number:
330-856-4079
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLEGGI
Authorized Official First Name:
ALBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-726-9006

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)

  • Identifier: 2119559 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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