1326305566 NPI number — AIRLIE RADIOLOGY PA

Table of content: (NPI 1326305566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326305566 NPI number — AIRLIE RADIOLOGY PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIRLIE RADIOLOGY PA
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:
1326305566
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1318 AIRLIE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-3727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-200-1438
Provider Business Mailing Address Fax Number:
330-544-4075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1318 AIRLIE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-3727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-200-1438
Provider Business Practice Location Address Fax Number:
330-544-4075
Provider Enumeration Date:
04/12/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EASON
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
OWNER/RADIOLOGIST
Authorized Official Telephone Number:
910-200-1438

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  20123 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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