Provider Demographics
NPI:1609829290
Name:IMTEK SERVICES, LLC
Entity Type:Organization
Organization Name:IMTEK SERVICES, LLC
Other - Org Name:CALIFONRIA ADVANCED IMAGING AT ATHERTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:BELICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-884-3096
Mailing Address - Street 1:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3415
Mailing Address - Fax:415-883-0877
Practice Address - Street 1:3301 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHERTON
Practice Address - State:CA
Practice Address - Zip Code:94027-3812
Practice Address - Country:US
Practice Address - Phone:650-364-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1200X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR000314UMedicaid
CAP00080429OtherRAILROAD MEDICARE
CAP00080429OtherRAILROAD MEDICARE