=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053353599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH SHORE MAGNETIC IMAGING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 68 PROSPECT ST
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-532-8960
-----------------------------------------------------
Fax | 978-532-0633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 68 PROSPECT ST
-----------------------------------------------------
City | PEABODY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01960-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-532-8960
-----------------------------------------------------
Fax | 978-532-0633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. ELEANOR NONE RICHARDSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-573-3116
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | 4385
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------