Healthcare Provider Details

I. General information

NPI: 1982165056
Provider Name (Legal Business Name): IMAGING CONSULTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2019
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST
SOUTHBRIDGE MA
01550-4051
US

IV. Provider business mailing address

18201 VON KARMAN AVE
IRVINE CA
92612-1000
US

V. Phone/Fax

Practice location:
  • Phone: 800-544-3215
  • 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 Number
License Number State

VIII. Authorized Official

Name: TONI COOPER
Title or Position: DIRECTOR OF CREDENTIALING
Credential:
Phone: 754-206-6198