1174596852 NPI number — IMAGECARE LLC

Table of content: MR. IRVING LIONEL SILVER MA (NPI 1073669214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174596852 NPI number — IMAGECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGECARE 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:
1174596852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3480 PRESTON RIDGE RD STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-5462
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-300-0101
Provider Business Mailing Address Fax Number:
678-992-7455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
710 RABON RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-8903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-256-7646
Provider Business Practice Location Address Fax Number:
803-699-4073
Provider Enumeration Date:
02/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
GEOFFREY
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
SVP FINANCE AND REVENUE CYCLE
Authorized Official Telephone Number:
336-718-2078

Provider Taxonomy Codes

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

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

  • Identifier: CA5940 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".