1578637369 NPI number — FIRST CHOICE MOBILE RADIOLOGY SERVICE LLC

Table of content: LEAH KATHRYN HEISLER SLP (NPI 1174202444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578637369 NPI number — FIRST CHOICE MOBILE RADIOLOGY SERVICE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE MOBILE RADIOLOGY SERVICE 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:
1578637369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
181 W ORANGETHORPE AVE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLACENTIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92870-6931
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-798-9886
Provider Business Mailing Address Fax Number:
626-771-3250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 W ORANGETHORPE AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-6931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-798-9886
Provider Business Practice Location Address Fax Number:
626-771-3250
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
KURT
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
714-798-9886

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X , with the licence number:  RHT 68902 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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