1932164522 NPI number — NORTH SHORE RADIOLOGICAL ASSOCIATES, INC.

Table of content: (NPI 1932164522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932164522 NPI number — NORTH SHORE RADIOLOGICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH SHORE RADIOLOGICAL ASSOCIATES, 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:
1932164522
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6750
Provider Second Line Business Mailing Address:
PAYMENT REMITTACE, CORRESPONDENCE AND CREDENTIALING
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03802-6750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-208-7069
Provider Business Mailing Address Fax Number:
610-956-0009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 UNICORN PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
WOBURN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-943-5580
Provider Business Practice Location Address Fax Number:
603-717-7445
Provider Enumeration Date:
04/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATTHEWS
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
800-208-7069

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: 9714847 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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