Provider Demographics
NPI:1376628263
Name:NORTHSTAR IMAGING INC
Entity Type:Organization
Organization Name:NORTHSTAR IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:LECKIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-813-8054
Mailing Address - Street 1:PO BOX 32936
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2936
Mailing Address - Country:US
Mailing Address - Phone:877-905-6553
Mailing Address - Fax:608-788-8799
Practice Address - Street 1:118 E HASKELL ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3247
Practice Address - Country:US
Practice Address - Phone:775-623-5222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV300075919OtherRAILROAD MEDICARE
UTDB5649OtherRAILROAD MEDICARE
NV100500055Medicaid
NVV36909Medicare ID - Type UnspecifiedCENTRAL AND SOUTHERN CNTY
NV300075919OtherRAILROAD MEDICARE
UT000057721Medicare PIN
UTDB5649OtherRAILROAD MEDICARE