Provider Demographics
NPI:1033527502
Name:SHIELDS IMAGING OF PORTSMOUTH LLC
Entity Type:Organization
Organization Name:SHIELDS IMAGING OF PORTSMOUTH LLC
Other - Org Name:SHIELDS MRI PORTSMOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-376-7416
Mailing Address - Street 1:55 CHRISTY DR
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1813
Mailing Address - Country:US
Mailing Address - Phone:508-897-1501
Mailing Address - Fax:508-897-1599
Practice Address - Street 1:1900 LAFAYETTE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5679
Practice Address - Country:US
Practice Address - Phone:800-258-4674
Practice Address - Fax:800-253-7569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)