Healthcare Provider Details

I. General information

NPI: 1568411122
Provider Name (Legal Business Name): SFRMI, PC - RAYTEL MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 CALIFORNIA ST
SAN FRANCISCO CA
94118-1837
US

IV. Provider business mailing address

7 WATERSIDE XING 3RD FLOOR ATTN: KAREN FRISK, CONTRACTING
WINDSOR CT
06095-1540
US

V. Phone/Fax

Practice location:
  • Phone: 415-922-6767
  • Fax: 415-563-0468
Mailing address:
  • Phone: 800-367-1095
  • Fax: 860-298-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number349949
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFREY M FLANEGIN
Title or Position: PRESIDENT
Credential:
Phone: 610-831-1112