Healthcare Provider Details

I. General information

NPI: 1700597481
Provider Name (Legal Business Name): SPIRIT IMAGING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2022
Last Update Date: 04/05/2024
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SILVERSIDE RD STE 135
WILMINGTON DE
19809-1377
US

IV. Provider business mailing address

501 SILVERSIDE RD STE 135
WILMINGTON DE
19809-1377
US

V. Phone/Fax

Practice location:
  • Phone: 302-448-8698
  • Fax: 302-397-2828
Mailing address:
  • Phone: 302-448-8698
  • Fax: 302-269-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD TYAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 302-448-8698