=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750651451
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUBE IMAGING PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2012
-----------------------------------------------------
Last Update Date | 01/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 249 E LAKE EMILY RD
-----------------------------------------------------
City | CRYSTAL FALLS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49920-8511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-365-3161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2837 US 41 W
-----------------------------------------------------
City | MARQUETTE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49855-2252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-225-3964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CESAR P CUBE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 202-365-3161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 4301088316
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------