Provider Demographics
NPI:1548567142
Name:TEOMAR IMAGING PLC
Entity Type:Organization
Organization Name:TEOMAR IMAGING PLC
Other - Org Name:IRON MOUNTAIN VEIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPONIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-834-6292
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-0767
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1115 S HEMLOCK ST
Practice Address - Street 2:SUITE 3
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3800
Practice Address - Country:US
Practice Address - Phone:855-834-6292
Practice Address - Fax:855-834-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076417202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty