1992844088 NPI number — MEDICAL CENTER MAGNETIC IMAGING, LLC

Table of content: (NPI 1992844088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992844088 NPI number — MEDICAL CENTER MAGNETIC IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CENTER MAGNETIC 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:
1992844088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 TELEGRAPH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609-3218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-869-8777
Provider Business Mailing Address Fax Number:
510-893-0332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 TELEGRAPH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-869-8777
Provider Business Practice Location Address Fax Number:
510-893-0332
Provider Enumeration Date:
02/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
AARON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
510-869-6825

Provider Taxonomy Codes

  • Taxonomy code: 2085N0904X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FG666A . This is a "MEDICARE PTAN - PETCT AND CT" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00118317 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ27496Z . This is a "MEDICARE PTAN - MRI" identifier . This identifiers is of the category "OTHER".