1366409864 NPI number — PIKE CREEK IMAGING ENTERPRISES LLC

Table of content: (NPI 1366409864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366409864 NPI number — PIKE CREEK IMAGING ENTERPRISES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIKE CREEK IMAGING ENTERPRISES 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:
1366409864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 MILLTOWN RD
Provider Second Line Business Mailing Address:
SUITE 13
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-4027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-993-2330
Provider Business Mailing Address Fax Number:
302-993-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 LIMESTONE RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19808-2147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-995-2037
Provider Business Practice Location Address Fax Number:
302-633-9311
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEACOCK
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PROJECT MANAGER
Authorized Official Telephone Number:
302-993-2330

Provider Taxonomy Codes

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

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

  • Identifier: 0000906902 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".




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