1437247244 NPI number — AURORA BREAST MRI OF CENTRAL MASSACHUSETTS, LLC

Table of content: (NPI 1437247244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437247244 NPI number — AURORA BREAST MRI OF CENTRAL MASSACHUSETTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AURORA BREAST MRI OF CENTRAL MASSACHUSETTS, LLC
Provider Last Name:
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Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1437247244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 HIGH ST
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:
01845-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-975-7530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 BELMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01605-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-459-7480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FANDEL
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
978-975-7530

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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