1952476780 NPI number — AURORA BREAST MRI OF ORANGE COUNTY LLC

Table of content: (NPI 1952476780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952476780 NPI number — AURORA BREAST MRI OF ORANGE COUNTY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA BREAST MRI OF ORANGE COUNTY 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:
1952476780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 HIGH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-975-1283
Provider Business Mailing Address Fax Number:
978-975-3181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DR
Provider Second Line Business Practice Location Address:
BLDG 20
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-8198
Provider Business Practice Location Address Fax Number:
714-456-8199
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAMES
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT
Authorized Official Telephone Number:
978-975-7530

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1200X , with the licence number: 200631510025 , 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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