1689669046 NPI number — INSIGHT IMAGING LLC

Table of content: (NPI 1689669046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689669046 NPI number — INSIGHT IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT IMAGING 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:
VIDERE DIAGNOSTICS
Provider Other Organization Name Type Code:
3
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:
1689669046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9930 KINCEY AVE STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078-6541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-525-7005
Provider Business Mailing Address Fax Number:
704-525-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9930 KINCEY AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078-6541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-525-7005
Provider Business Practice Location Address Fax Number:
704-525-6250
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOUKNIGHT
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
704-525-7005

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2881776 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: P00228084 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00345675 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 47BBBJF . This is a "CAHABA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00008129 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: Q335650001 . This is a "PALMETTO GBA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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