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

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 Field Definition 1
1 NPI 1720340995 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name MRI IMAGING SPECIALIST The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 6760 JIMMY CARTER BLVD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name NORCROSS The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name GA The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 300711278 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 6789690904 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 6789690908 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 6/13/2012 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 6/27/2012 The date that a record was last updated or changed.
14 Authorized Official Last Name ALTORE The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name MIGUEL The first name of the authorized official.
16 Authorized Official Title or Position CEO The title or position of the authorized official.
17 Authorized Official Telephone Number 6789690904 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 261Q00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
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: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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