Provider Demographics
NPI:1154653087
Name:NUCLEAR CARDIAC IMAGING, LLC
Entity Type:Organization
Organization Name:NUCLEAR CARDIAC IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHARRARD
Authorized Official - Suffix:
Authorized Official - Credentials:RTN
Authorized Official - Phone:989-326-0929
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:KAWKAWLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48631-0398
Mailing Address - Country:US
Mailing Address - Phone:989-667-6780
Mailing Address - Fax:989-488-4444
Practice Address - Street 1:3491 S HURON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-1547
Practice Address - Country:US
Practice Address - Phone:989-667-6980
Practice Address - Fax:989-488-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDS112843207U00000X
207UN0901X, 2085N0904X, 2085R0202X, 2471N0900X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700Z90137OtherBCBS OF MI
MIMI2514Medicare PIN