Basic Information
| Provider Information | |||||||||
| NPI: | 1184660037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMAGING CONSULTANTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 FEDERAL ST | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018101039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9785522600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 840 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021182905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176388000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BLOOM | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9785522600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0208X | 440413 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile |
ID Information
| ID | Type | State | Issuer | Description | 785146 | 01 | MA | CONNECTICARE | OTHER | 9752731 B | 05 | MA | MEDICAID | 0421008 | 01 | MA | CIGNA / HEALTHSOURCE | OTHER | 36984 | 01 | MA | FALLON | OTHER | 9758861 | 05 | MA | MEDICAID | 036769 | 01 | MA | BCBS | OTHER | 13270 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 626264 | 01 | MA | HARVARD PILGRIM HLTH CARE | OTHER | 0008850 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 713587 | 01 | MA | TUFTS/SECURE HORIZONS | OTHER | 81020 | 01 | MA | AETNA | OTHER |