1841447927 NPI number — STEWARD PET IMAGING, 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 1841447927 NPI number — STEWARD PET IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEWARD PET 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:
STEWARD PET IMAGING, LLC AT ST. ELIZABETH'S MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1841447927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062-3487
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-877-8455
Provider Business Mailing Address Fax Number:
866-927-0079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
735 CAMBRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02135-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-877-8455
Provider Business Practice Location Address Fax Number:
866-927-0079
Provider Enumeration Date:
08/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GUYON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
617-789-5047

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X , with the licence number:  4NNJ , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110073236B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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