Provider Demographics
NPI:1063459253
Name:NEHE WSIC II LLC
Entity Type:Organization
Organization Name:NEHE WSIC II LLC
Other - Org Name:WEST SUBURBAN IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP &CFO
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AIHARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:100 BAYVIEW CIR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2983
Mailing Address - Country:US
Mailing Address - Phone:949-242-5300
Mailing Address - Fax:
Practice Address - Street 1:366 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY HILLS
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:781-239-0033
Practice Address - Fax:781-237-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2014-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529188Medicaid
MA1529188Medicaid