Provider Demographics
NPI:1508297144
Name:COOLIDGE IMAGING LLC
Entity Type:Organization
Organization Name:COOLIDGE IMAGING LLC
Other - Org Name:PARKWOOD OPEN IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIPIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-268-2789
Mailing Address - Street 1:13161 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-4630
Mailing Address - Country:US
Mailing Address - Phone:248-268-2789
Mailing Address - Fax:248-291-6718
Practice Address - Street 1:13161 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-4630
Practice Address - Country:US
Practice Address - Phone:248-268-2789
Practice Address - Fax:248-291-6718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)