1952335135 NPI number — OLSON IMAGING LLC

Table of content: (NPI 1952335135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952335135 NPI number — OLSON IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLSON 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:
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:
1952335135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2424 N GRAND AVE
Provider Second Line Business Mailing Address:
STE A1
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-479-0461
Provider Business Mailing Address Fax Number:
714-479-0463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 N STEPHANIE ST
Provider Second Line Business Practice Location Address:
STE 423
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89014-2633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-340-7111
Provider Business Practice Location Address Fax Number:
714-479-0463
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCINTRYE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
714-479-0461

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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