Healthcare Provider Details

I. General information

NPI: 1073777264
Provider Name (Legal Business Name): NORTHSTAR IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MCCABE DR
RENO NV
89511-5991
US

IV. Provider business mailing address

6490 S MCCARRAN BLVD STE 22
RENO NV
89509-6123
US

V. Phone/Fax

Practice location:
  • Phone: 775-852-5444
  • Fax:
Mailing address:
  • Phone: 775-829-9880
  • Fax: 775-829-9876

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: DANIEL ALLEN PENNEBAKER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 775-829-9880