1962438549 NPI number — IMAGE INTERPRETATION SERVICES LTD

Table of content: (NPI 1962438549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962438549 NPI number — IMAGE INTERPRETATION SERVICES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMAGE INTERPRETATION SERVICES LTD
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:
1962438549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 76648
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44101-6500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-266-4908
Provider Business Mailing Address Fax Number:
740-264-4376

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINGO JCT
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43938-1463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-266-4908
Provider Business Practice Location Address Fax Number:
740-264-4376
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BALZANO
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
740-266-4908

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  OH350780001B , 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: 2268460 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com