Provider Demographics
NPI:1417906983
Name:TROLLEY SQUARE OPEN MRI AND IMAGING CENTER, LLC
Entity Type:Organization
Organization Name:TROLLEY SQUARE OPEN MRI AND IMAGING CENTER, LLC
Other - Org Name:BANCROFT PARKWAY OPEN MRI & IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:302-246-2000
Mailing Address - Street 1:1010 N BANCROFT PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2690
Mailing Address - Country:US
Mailing Address - Phone:302-472-5555
Mailing Address - Fax:302-472-9998
Practice Address - Street 1:1010 N BANCROFT PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-2690
Practice Address - Country:US
Practice Address - Phone:302-472-5555
Practice Address - Fax:302-472-9998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE20042107152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEFDXVU4Medicare PIN