Provider Demographics
NPI:1114328861
Name:MEDQUEST IMAGING L.L.C
Entity Type:Organization
Organization Name:MEDQUEST IMAGING L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:
Authorized Official - First Name:AMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-655-4544
Mailing Address - Street 1:3400 FLECKENSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3042
Mailing Address - Country:US
Mailing Address - Phone:810-391-5057
Mailing Address - Fax:810-733-6662
Practice Address - Street 1:3400 FLECKENSTEIN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3042
Practice Address - Country:US
Practice Address - Phone:810-391-5057
Practice Address - Fax:810-733-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-12
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301054378Other4301054378