Healthcare Provider Details

I. General information

NPI: 1891881066
Provider Name (Legal Business Name): EAST BELTLINE IMAGING PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 EAGLE RUN DR NE
GRAND RAPIDS MI
49525-7051
US

IV. Provider business mailing address

3210 EAGLE RUN DR NE
GRAND RAPIDS MI
49525-7051
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-7500
  • Fax: 616-301-3606
Mailing address:
  • Phone: 616-301-7500
  • Fax: 616-301-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberHS062163
License Number StateMI

VIII. Authorized Official

Name: MEGAN TARATUTA
Title or Position: OFFICE MANAGER
Credential: PAC
Phone: 616-456-9553