1184660037 NPI number — IMAGING CONSULTANTS, INC.

Table of content: (NPI 1184660037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184660037 NPI number — IMAGING CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGING CONSULTANTS, INC.
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:
1184660037
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:
600 FEDERAL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01810-1039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-552-2600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02118-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-638-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLOOM
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-552-2600

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X , with the licence number:  440413 , 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: 785146 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9752731 B , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0421008 . This is a "CIGNA / HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 36984 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9758861 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036769 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 13270 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 626264 . This is a "HARVARD PILGRIM HLTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008850 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 713587 . This is a "TUFTS/SECURE HORIZONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 81020 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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