1710200845 NPI number — PARTNERS IMAGING CENTER OF CHARLOTTE LLC

Table of content: (NPI 1710200845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710200845 NPI number — PARTNERS IMAGING CENTER OF CHARLOTTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARTNERS IMAGING CENTER OF CHARLOTTE 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:
PARTNERS IMAGING CENTER OF PORT CHARLOTTE
Provider Other Organization Name Type Code:
5
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:
1710200845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
848 N RAINBOW BLVD STE 2494
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89107-1103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-700-1093
Provider Business Mailing Address Fax Number:
877-484-5173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4161 TAMIAMI TRL STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-9204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-255-5151
Provider Business Practice Location Address Fax Number:
941-255-5152
Provider Enumeration Date:
03/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GEISLER
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
647-288-1508

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  HCC10461 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0200X , with the licence number: HCC10461 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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