1659322360 NPI number — U S LAB & RADIOLOGY LLC

Table of content: (NPI 1659322360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659322360 NPI number — U S LAB & RADIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
U S LAB & RADIOLOGY 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:
1659322360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 JONATHAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROCKTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02301-5549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-583-2000
Provider Business Mailing Address Fax Number:
508-895-9509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 JONATHAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02301-5549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-583-2000
Provider Business Practice Location Address Fax Number:
438-427-2644
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUOMO
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
AUTHORIZED OFFICIAL/CFO
Authorized Official Telephone Number:
717-891-6838

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  2253 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 30009485 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3080795 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 690006929 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: S028178 . This is a "CHAMPUS - TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 153720000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: TR0022 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110025611A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: US16844 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35-00040 . This is a "UNITED HEALTHCARE - NEW E" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2433-2 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0009535 . This is a "NEIGHBORHOOD HLTH PLANS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011601 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1659322360 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3098416 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35-00001 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 800498 . This is a "HARVARD/PILGRIM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 803790 . This is a "TUFTS HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000021168 . This is a "BOSTON MED HLTHNET PLAN" identifier . This identifiers is of the category "OTHER".




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