1114977337 NPI number — INSIGHT-PREMIER HEALTH 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 1114977337 NPI number — INSIGHT-PREMIER HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT-PREMIER HEALTH 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:
RAYUS RADIOLOGY SKOWHEGAN
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:
1114977337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 414025
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02241-4025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-674-7933
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 FAIRVIEW AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOWHEGAN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04976-1481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-734-4132
Provider Business Practice Location Address Fax Number:
800-883-6348
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
AHERN
Authorized Official First Name:
RAMONA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SPECIAL ASSISTANT SECRETARY
Authorized Official Telephone Number:
952-738-4441

Provider Taxonomy Codes

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

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

  • Identifier: 470001124 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 133960000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com