Provider Demographics
NPI:1023202033
Name:UNIVERSITY IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:UNIVERSITY IMAGING CENTER, LLC
Other - Org Name:UNIVERSITY IMAGING CENTER OF HADDONFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-692-1198
Mailing Address - Street 1:66 TANNER ST
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2419
Mailing Address - Country:US
Mailing Address - Phone:856-216-0294
Mailing Address - Fax:856-216-0299
Practice Address - Street 1:66 TANNER ST
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2419
Practice Address - Country:US
Practice Address - Phone:856-216-0294
Practice Address - Fax:856-216-0299
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY IMAGING CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23321261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124069Medicare UPIN