1699818716 NPI number — SOUTHTOWNS CATHOLIC MRI LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699818716 NPI number — SOUTHTOWNS CATHOLIC MRI LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHTOWNS CATHOLIC MRI 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:
1699818716
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:
3040 AMSDELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMBURG
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14075-5835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-649-9000
Provider Business Mailing Address Fax Number:
716-649-9005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3669 SOUTHWESTERN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORCHARD PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14127-1732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-662-8543
Provider Business Practice Location Address Fax Number:
716-662-8590
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JOYCE
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
716-662-8543

Provider Taxonomy Codes

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

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

  • Identifier: 02002899 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com