1154653152 NPI number — OIS METROPOLITAN IMAGING LLC

Table of content: (NPI 1154653152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154653152 NPI number — OIS METROPOLITAN IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OIS METROPOLITAN 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:
1154653152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JOHNSTON ST
Provider Second Line Business Mailing Address:
STE 12
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-5531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-303-0165
Provider Business Mailing Address Fax Number:
912-354-5119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 EISENHOWER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-2668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-303-0165
Provider Business Practice Location Address Fax Number:
912-354-5119
Provider Enumeration Date:
02/02/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
912-303-0165

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085D0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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" .
  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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