Provider Demographics
NPI:1639111958
Name:WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC
Entity Type:Organization
Organization Name:WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:18201 VON KARMAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1176
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:2033 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331-3535
Practice Address - Country:US
Practice Address - Phone:978-249-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4380261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA711456OtherTUFTS/SECURE HORIZONS
MA102330300OtherU.S. DEPT OF LABOR OWCP
MA985455OtherNETWORK HEALTH
MA0113178OtherAETNA
MA603303OtherHARVARD PILGRIM HEALTH CA
MA1530259Medicaid
MA17687OtherHEALTH NEW ENGLAND
MA0418278OtherCIGNA / HEALTHSOURCE
MA000000006899OtherBOSTON MC HEALTHNET PLAN
MA017769OtherBCBS
MA65689OtherFALLON
MA0008340OtherNEIGHBORHOOD HEALTH PLAN
MA740694OtherCONNECTICARE
MA65689OtherFALLON
MA1530259Medicaid