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1639111958

NPI Code Detail

MEDICARE: WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC

MEDICARE: WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0208X	Mobile Radiology Clinic/Center	4380	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	711456	OTHER	MA	TUFTS/SECURE HORIZONS
2	102330300	OTHER	MA	U.S. DEPT OF LABOR OWCP
3	985455	OTHER	MA	NETWORK HEALTH
4	0113178	OTHER	MA	AETNA
5	603303	OTHER	MA	HARVARD PILGRIM HEALTH CA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	17687	OTHER	MA	HEALTH NEW ENGLAND
8	0418278	OTHER	MA	CIGNA / HEALTHSOURCE
9	000000006899	OTHER	MA	BOSTON MC HEALTHNET PLAN
10	017769	OTHER	MA	BCBS
11	65689	OTHER	MA	FALLON
12	0008340	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
13	740694	OTHER	MA	CONNECTICARE

General Provider Information

NPI Number	:	1639111958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC

Provider Business Mailing Address
First Line	:	18201 VON KARMAN AVE STE 600
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-1176
Country	:	US
Telephone Number	:	800-544-3215
Fax Number	:

Provider Business Practice Location Address
First Line	:	2033 MAIN ST
Second Line	:
City	:	ATHOL
State	:	MA
Zip	:	01331-3535
Country	:	US
Telephone Number	:	978-249-3511
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	WILLIAM LARKIN
Credential	:
Telephone Number	:	800-544-3215

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	12/30/2019

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Directions to “WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC ” Practice Location

Language	Start Address	Practice Location

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