MRI IMAGING SPECIALIST - NPI NUMBER 1720340995

Summary

Provider Name: MRI IMAGING SPECIALIST

NPI Number: 1720340995

Clasification: Clinic/Center (261Q00000X)

Address:
6760 JIMMY CARTER BLVD
NORCROSS, GA
ZIP 30071

Phone Number: (678) 969-0904



Detailed Information

MRI IMAGING SPECIALIST is a clinic/center in Norcross, GA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). The assigned NPI number for this provider is 1720340995 and is registered as an organization entity type.

The provider's business address is:

6760 JIMMY CARTER BLVD
NORCROSS, GA
ZIP 30071-278
Phone: (678) 969-0904
Fax: (678) 969-0908

The provider's authorized official is Miguel Altore .
The authorized official title is Ceo and has the following contact phone number (678) 969-0904.

The enumeration date for this NPI number is 6/13/2012 and was last updated on 6/27/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261Q00000X Clinic/Center No
2 261QM1300X Clinic/Center Multi-Specialty No
3 261QR0200X Clinic/Center Radiology No
4 261QR0206X Clinic/Center Radiology, Mammography No
5 261QM1200X Clinic/Center Magnetic Resonance Imaging (MRI) Yes

NPI Record

No. Field Name Field Value
1 NPI 1720340995
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name MRI IMAGING SPECIALIST
5 Provider First Line Business Practice Location Address 6760 JIMMY CARTER BLVD
6 Provider Business Practice Location Address City Name NORCROSS
7 Provider Business Practice Location Address State Name GA
8 Provider Business Practice Location Address Postal Code 300711278
9 Provider Business Practice Location Address Country Code If outside U S US
10 Provider Business Practice Location Address Telephone Number 6789690904
11 Provider Business Practice Location Address Fax Number 6789690908
12 Provider Enumeration Date 6/13/2012
13 Last Update Date 6/27/2012
14 Authorized Official Last Name ALTORE
15 Authorized Official First Name MIGUEL
16 Authorized Official Title or Position CEO
17 Authorized Official Telephone Number 6789690904
18 Healthcare Provider Taxonomy Code 1 261Q00000X
19 Healthcare Provider Primary Taxonomy Switch 1 N
20 Healthcare Provider Taxonomy Code 2 261QM1300X
21 Healthcare Provider Primary Taxonomy Switch 2 N
22 Healthcare Provider Taxonomy Code 3 261QR0200X
23 Healthcare Provider Primary Taxonomy Switch 3 N
24 Healthcare Provider Taxonomy Code 4 261QR0206X
25 Healthcare Provider Primary Taxonomy Switch 4 N
26 Healthcare Provider Taxonomy Code 5 261QM1200X
27 Healthcare Provider Primary Taxonomy Switch 5 Y
28 Is Organization Subpart N
29 Authorized Official Name Prefix Text MR.

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.