Provider Demographics
NPI:1073121521
Name:EXECUTIVE IMAGING, LLC
Entity Type:Organization
Organization Name:EXECUTIVE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEMPSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-387-7200
Mailing Address - Street 1:1069 DELAWARE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6459
Mailing Address - Country:US
Mailing Address - Phone:740-751-6828
Mailing Address - Fax:740-751-6829
Practice Address - Street 1:1069 DELAWARE AVE STE 104
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6459
Practice Address - Country:US
Practice Address - Phone:740-751-6828
Practice Address - Fax:740-751-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology