=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801851340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST BAY MEDICAL IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2006
-----------------------------------------------------
Last Update Date | 05/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2242 CAMINO RAMON STE 100
-----------------------------------------------------
City | SAN RAMON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94583-1352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-327-0015
-----------------------------------------------------
Fax | 925-327-0095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 404166 LEGAL DEPT
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30384-4166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-282-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR VP & CHIEF ACCOUNTING OFCR
-----------------------------------------------------
Name | MR. BRIAN G DRAZBA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-282-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------