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General NPI Number Information
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NPI Number | 1184902975
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Entity Type | Organization
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Legal Business Name | ICI 24 7 PC
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 07/27/2011
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Provider Practice Location Address
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Address Line | 3305 CORINTH PKWY
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City | CORINTH
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State | TX
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Zip | 76208-5380
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Country | US
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Telephone | 940-270-4100
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Fax | 602-345-7733
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Provider Business Mailing Address
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Address Line | 100 BAYVIEW CIR SUITE 400
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2983
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Country | US
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Telephone | 949-242-5300
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Fax | 602-345-7733
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID L BLOOM
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Credential | M.D
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Telephone | 978-552-2732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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