1992006720 NPI number — INSIGHT IMAGING INC

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 1992006720 NPI number — INSIGHT IMAGING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHT IMAGING INC
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:
1992006720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 LITTON DR
Provider Second Line Business Mailing Address:
SUITE #208
Provider Business Mailing Address City Name:
GRASS VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95945-5077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-273-2770
Provider Business Mailing Address Fax Number:
530-271-3239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 LITTON DR
Provider Second Line Business Practice Location Address:
SUITE #208
Provider Business Practice Location Address City Name:
GRASS VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95945-5077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-273-2770
Provider Business Practice Location Address Fax Number:
530-271-3239
Provider Enumeration Date:
11/10/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AGNESS
Authorized Official First Name:
MELISA
Authorized Official Middle Name:
MOORE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
530-273-2770

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  A45512 , 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)