1487690335 NPI number — IMAGING CONSULTANTS INC

Table of content: (NPI 1487690335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487690335 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:
1487690335
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/22/2006
NPI Reactivation Date:
11/26/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 BAYVIEW CIR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-2984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-242-5384
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
761 WORCESTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01701-5224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-245-5995
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:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-552-2600

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  440327 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036769 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 785146 . This is a "CONNECTICARE" 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: 36984 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0421008 . This is a "CIGNA / HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1529871 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00021368 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 346646400 . This is a "U.S. DEPT OF LABOR OWCP" 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: 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".




Copyright © 2007-2024 www.npivalidator.com