MEDICARE: PRIME IMAGING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1669691549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME IMAGING INC

Provider Business Mailing Address
First Line	:	417 ARDEN AVE
Second Line	:	112A
City	:	GLENDALE
State	:	CA
Zip	:	91203-4045
Country	:	US
Telephone Number	:	818-662-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	417 ARDEN AVE
Second Line	:	112A
City	:	GLENDALE
State	:	CA
Zip	:	91203-4045
Country	:	US
Telephone Number	:	818-662-9700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KAREN SETANYAN
Credential	:
Telephone Number	:	818-662-9700

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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