Provider Demographics
NPI:1376599837
Name:COVENANT BREAST IMAGING CENTER SAGINAW LLC
Entity Type:Organization
Organization Name:COVENANT BREAST IMAGING CENTER SAGINAW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAKRISHNAYYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-753-9000
Mailing Address - Street 1:3400 N CENTER RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7920
Mailing Address - Country:US
Mailing Address - Phone:989-753-9000
Mailing Address - Fax:989-753-4024
Practice Address - Street 1:5570 STATE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3583
Practice Address - Country:US
Practice Address - Phone:989-583-0115
Practice Address - Fax:989-583-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P49390OtherMEDICARE
MI0N20770Medicare ID - Type Unspecified