1396779237 NPI number — ADVANCED MOBILE IMAGING, LLC

Table of content: RACHEL LORENE TUCKER MHPP (NPI 1255377479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396779237 NPI number — ADVANCED MOBILE IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MOBILE 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:
1396779237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 416
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06460-0416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-878-6768
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 NEW HAVEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06460-4854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-878-6768
Provider Business Practice Location Address Fax Number:
203-878-6087
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ELZIN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
203-878-6768

Provider Taxonomy Codes

  • Taxonomy code: 2085U0001X , with the licence number:  81408 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471B0102X , with the licence number: 003259 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247200000X , with the licence number: 003259 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335V00000X , with the licence number: 003259 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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