1508979089 NPI number — ECG SCANNING & MEDICAL SERVICES INC

Table of content: (NPI 1508979089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508979089 NPI number — ECG SCANNING & MEDICAL SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECG SCANNING & MEDICAL SERVICES 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:
1508979089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3055 KETTERLING BLVD
Provider Second Line Business Mailing Address:
SUITE 219
Provider Business Mailing Address City Name:
DAYTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45439-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-346-5837
Provider Business Mailing Address Fax Number:
937-395-4415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18223 E TEN MILE ROAD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROSEVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48066-5281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-948-3803
Provider Business Practice Location Address Fax Number:
586-948-3804
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NASUTI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
800-346-5837

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  0787141 , 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: 8462355 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1002973 . This is a "HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2338764 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85572A . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OF3159 . This is a "BCBS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060F373720 . This is a "BCBS OF MICHIGAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134910001 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 60E9 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: RAOH0013 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 470000255 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: P81358 . This is a "BLUE CARE NETWORK HMO" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200014360A . This is a "INDIANA HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4631482 . This is a "CARE CHOICES" identifier . This identifiers is of the category "OTHER".




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