1194733246 NPI number — WOODLAND DIAGNOSTIC IMAGING LLC

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 1194733246 NPI number — WOODLAND DIAGNOSTIC IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLAND DIAGNOSTIC 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:
6
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:
1194733246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18201 VON KARMAN AVE STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92612-1176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-544-3215
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5005 WHIPPLE AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-493-6747
Provider Business Practice Location Address Fax Number:
330-493-6947
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KASSA
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR VICE PRESIDENT
Authorized Official Telephone Number:
904-300-2777

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X , with the licence number:  1037IC , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100897 . This is a "KAISER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 20028 . This is a "MEDFOCUS RADIOLOGY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000167494 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 359986300 . This is a "ACS/US DEPT OF LABOR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 47659-0001 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2460699 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 731339 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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