Provider Demographics
NPI:1326091380
Name:MASSTEX IMAGING, LLC
Entity Type:Organization
Organization Name:MASSTEX IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOM
Authorized Official - Prefix:MR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-275-1834
Mailing Address - Street 1:6078 BRIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1126
Mailing Address - Country:US
Mailing Address - Phone:805-275-1834
Mailing Address - Fax:877-293-1573
Practice Address - Street 1:3 ELECTRONICS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1099
Practice Address - Country:US
Practice Address - Phone:800-508-6277
Practice Address - Fax:978-232-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21773Medicare PIN
ME001350501Medicare PIN
RI0013505Medicare PIN
CTD100006954Medicare PIN