1053353599 NPI number — NORTH SHORE MAGNETIC IMAGING CENTER

Table of content: (NPI 1053353599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053353599 NPI number — NORTH SHORE MAGNETIC IMAGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE MAGNETIC IMAGING CENTER
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:
1053353599
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:
68 PROSPECT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEABODY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01960-1605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-532-8960
Provider Business Mailing Address Fax Number:
978-532-0633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 PROSPECT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEABODY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01960-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-532-8960
Provider Business Practice Location Address Fax Number:
978-532-0633
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
ELEANOR
Authorized Official Middle Name:
NONE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
978-573-3116

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  4385 , 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: 29480 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 018169 . This is a "BC/BS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2226830784 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 605118 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007590 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1530496 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1600036 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 709656 . This is a "TUFTS HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 31612 . This is a "FALLON HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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