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General NPI Number Information
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NPI Number | 1073553582
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Entity Type | Organization
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Legal Business Name | MID AMERICAN IMAGING, INC.
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 1400 E 2ND ST
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City | DEFIANCE
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State | OH
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Zip | 43512-2440
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Country | US
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Telephone | 419-783-3239
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BAYVIEW CIRCLE SUITE 400
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2984
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Country | US
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Telephone | 800-544-3215
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Fax |
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Authorized Official
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Title or Position | EXEC VP & CFO
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Name | RHONDA LONGMORE GRUND
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Credential |
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Telephone | 800-544-3215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 02220180040
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License Number State | OH
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