Provider Demographics
NPI:1467435941
Name:SUPERIOR IMAGING SPECIALISTS, PC
Entity Type:Organization
Organization Name:SUPERIOR IMAGING SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-7808
Mailing Address - Street 1:2837 US 41 WEST
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-3964
Mailing Address - Fax:906-226-3875
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-7808
Practice Address - Fax:906-225-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010526762085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104968541Medicaid
MI310E210240OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI104352558Medicaid
MI104968532Medicaid
MI0N48910Medicare PIN
MI310E210240OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIA74136Medicare UPIN
DO4700Medicare PIN
MI104968532Medicaid
CJ2223Medicare PIN
MI0P44180Medicare PIN