1710907316 NPI number — PRECISION IMAGING LLC

Table of content: (NPI 1710907316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710907316 NPI number — PRECISION IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION 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:
1710907316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 EXECUTIVE BLVD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-3803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-656-7226
Provider Business Mailing Address Fax Number:
301-656-7225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 EXECUTIVE BLVD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-656-7226
Provider Business Practice Location Address Fax Number:
301-656-7225
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FAIRBANKS
Authorized Official First Name:
RALPH
Authorized Official Middle Name:
WILLIAMSON
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
301-656-7225

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: J245 . This is a "BCBS DC" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 020897500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1295755429 . This is a "DR. ROBERTO F. SOTO NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2118991 . This is a "MAMSI ( ALL) - PET" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4118991 . This is a "MAMSI (ALL) RAD SRV" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7185454 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: KFD9PR . This is a "BSBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 403570400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 491644 . This is a "NCPPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 613109700 . This is a "DOL FECA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9138029 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3118991 . This is a "MAMSI ( ALL) - MRI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3245529 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00209099 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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