Provider Demographics
NPI:1407898760
Name:NORTH SHORE PET IMAGING CENTER
Entity Type:Organization
Organization Name:NORTH SHORE PET IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-573-3116
Mailing Address - Street 1:68 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1605
Mailing Address - Country:US
Mailing Address - Phone:978-532-8960
Mailing Address - Fax:978-532-9163
Practice Address - Street 1:68 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1605
Practice Address - Country:US
Practice Address - Phone:978-532-8960
Practice Address - Fax:978-532-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4C5F261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA039669OtherBC/BS OF MA
MA641402OtherTUFTS HEALTH PLAN
MA0034316OtherNEIGHBORHOOD HEALTH
MA3732728OtherAETNA
MAAA20785OtherHARVARD PILGRIM HEALTH
MA=========OtherCHAMPUS/TRICARE
MA=========OtherUNITED HEALTHCARE
MA0034316OtherNEIGHBORHOOD HEALTH
MA641402OtherTUFTS HEALTH PLAN