Provider Demographics
NPI:1457332967
Name:NORTHWEST DIAGNOSTIC IMAGING, INC
Entity Type:Organization
Organization Name:NORTHWEST DIAGNOSTIC IMAGING, INC
Other - Org Name:OPEN MRI & IMAGING OF ALBANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-300-0101
Mailing Address - Street 1:PO BOX 932391
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2391
Mailing Address - Country:US
Mailing Address - Phone:678-393-5600
Mailing Address - Fax:770-300-9018
Practice Address - Street 1:2416 WESTGATE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-8204
Practice Address - Country:US
Practice Address - Phone:229-483-9888
Practice Address - Fax:229-436-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========AMedicare ID - Type Unspecified