Healthcare Provider Details

I. General information

NPI: 1639111958
Provider Name (Legal Business Name): WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2033 MAIN ST
ATHOL MA
01331-3535
US

IV. Provider business mailing address

18201 VON KARMAN AVE STE 600
IRVINE CA
92612-1176
US

V. Phone/Fax

Practice location:
  • Phone: 978-249-3511
  • Fax:
Mailing address:
  • Phone: 800-544-3215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number4380
License Number StateMA

VIII. Authorized Official

Name: WILLIAM LARKIN
Title or Position: CFO
Credential:
Phone: 800-544-3215