Provider Demographics
NPI:1568596732
Name:SPINAL IMAGING INC
Entity Type:Organization
Organization Name:SPINAL IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MANDEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-238-0600
Mailing Address - Street 1:5 NORFOLK AVE
Mailing Address - Street 2:PO BOX 1200
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1157
Mailing Address - Country:US
Mailing Address - Phone:508-238-0600
Mailing Address - Fax:508-238-0786
Practice Address - Street 1:5 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1157
Practice Address - Country:US
Practice Address - Phone:508-238-0600
Practice Address - Fax:508-238-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MACH2416111NR0200X
MSCE004979111NR0200X
247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAHE Y45291Medicare ID - Type Unspecified
MAU78594Medicare UPIN
MOU05670Medicare UPIN