Provider Demographics
NPI:1619047537
Name:WEYMOUTH MRI PC
Entity Type:Organization
Organization Name:WEYMOUTH MRI PC
Other - Org Name:SEACOAST ADVANCED DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-888-2270
Mailing Address - Street 1:3 CEDARHILL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2226
Mailing Address - Country:US
Mailing Address - Phone:508-888-2270
Mailing Address - Fax:508-888-2544
Practice Address - Street 1:3 CEDARHILL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2226
Practice Address - Country:US
Practice Address - Phone:508-888-2270
Practice Address - Fax:508-888-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1534181Medicaid
MAM15236Medicare PIN
M15236Medicare PIN