Basic Information
| Provider Information | |||||||||
| NPI: | 1063459253 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEHE WSIC II LLC | ||||||||
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| OtherOrganizationName: | WEST SUBURBAN IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BAYVIEW CIR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926602983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492425300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 366 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | WELLESLEY HILLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02481 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7812390033 | ||||||||
| FaxNumber: | 7812378938 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 10/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | AIHARA | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXEC VP &CFO | ||||||||
| AuthorizedOfficialTelephone: | 8005443215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology | 261QM1200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) |
ID Information
| ID | Type | State | Issuer | Description | 1529188 | 05 | MA | MEDICAID |