Provider Demographics
NPI:1477768331
Name:INMED DIAGNOSTIC SERVICES OF MA, LLC
Entity Type:Organization
Organization Name:INMED DIAGNOSTIC SERVICES OF MA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:803-988-1093
Mailing Address - Street 1:40 QUINLAN WAY
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5232
Mailing Address - Country:US
Mailing Address - Phone:508-771-4708
Mailing Address - Fax:508-759-8178
Practice Address - Street 1:40 QUINLAN WAY
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5232
Practice Address - Country:US
Practice Address - Phone:508-771-4708
Practice Address - Fax:508-759-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAM395261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1541510Medicaid
MA460184OtherTUFTS
MA038869OtherBCBS
MA626447OtherHARVARD
MA1541510Medicaid