1376595470 NPI number — CHELSEA MRI PC

Table of content: (NPI 1376595470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376595470 NPI number — CHELSEA MRI PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHELSEA MRI PC
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:
THE MRI CENTER OF SPRINGFIELD
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:
1376595470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 W CUMMINGS PARK
Provider Second Line Business Mailing Address:
SUITE 1350
Provider Business Mailing Address City Name:
WOBURN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01801-6372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-569-6541
Provider Business Mailing Address Fax Number:
781-569-6557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01107-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-781-9000
Provider Business Practice Location Address Fax Number:
413-781-7988
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANTAMARIA
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
781-569-6541

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0200X , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 110028942/A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110028942/D , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M17165 . This is a "BC BS PROFESSIONAL #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 034869 . This is a "BC BS OF MA TECHNICAL #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110028942/C , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110028942/B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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