1639111958 NPI number — WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639111958 NPI number — WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES 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:
1639111958
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18201 VON KARMAN AVE STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-544-3215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2033 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHOL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01331-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-249-3511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LARKIN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
800-544-3215

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X , with the licence number:  4380 , 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: 711456 . This is a "TUFTS/SECURE HORIZONS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 102330300 . This is a "U.S. DEPT OF LABOR OWCP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 985455 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0113178 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 603303 . This is a "HARVARD PILGRIM HEALTH CA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1530259 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 17687 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0418278 . This is a "CIGNA / HEALTHSOURCE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000006899 . This is a "BOSTON MC HEALTHNET PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 017769 . This is a "BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 65689 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0008340 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 740694 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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