Healthcare Provider Details

I. General information

NPI: 1356223879
Provider Name (Legal Business Name): THE IMAGING CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 KENMOOR AVE SE
GRAND RAPIDS MI
49546-2302
US

IV. Provider business mailing address

710 KENMOOR AVE SE
GRAND RAPIDS MI
49546-2302
US

V. Phone/Fax

Practice location:
  • Phone: 616-617-2623
  • Fax:
Mailing address:
  • Phone: 616-617-2623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAY LABINE
Title or Position: OWNER
Credential:
Phone: 616-617-2623