Healthcare Provider Details

I. General information

NPI: 1306007141
Provider Name (Legal Business Name): NORTHSTAR IMAGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 AVENUE H
ELY NV
89301-2615
US

IV. Provider business mailing address

PO BOX 32936
KNOXVILLE TN
37930-2936
US

V. Phone/Fax

Practice location:
  • Phone: 775-289-3001
  • Fax:
Mailing address:
  • Phone: 877-905-6553
  • Fax: 608-788-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT LECKIE
Title or Position: TREASURER
Credential: MD
Phone: 775-813-8054