1588778807 NPI number — ADVANCED BERKSHIRE MEDICAL IMAGING, PC

Table of content: (NPI 1700057064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588778807 NPI number — ADVANCED BERKSHIRE MEDICAL IMAGING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED BERKSHIRE MEDICAL IMAGING, 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:
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:
1588778807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2527 CRANBERRY HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAREHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02571-1046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-841-5200
Provider Business Mailing Address Fax Number:
508-273-1241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 NORTH ST
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-395-7585
Provider Business Practice Location Address Fax Number:
413-395-7541
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MALKANI
Authorized Official First Name:
PRAKASH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-395-7585

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: 02722003 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003120219 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9728601 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018103300 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com