Provider Demographics
NPI:1639208366
Name:NORTH BAY IMAGING LLC
Entity Type:Organization
Organization Name:NORTH BAY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-785-7226
Mailing Address - Street 1:625 W BALDWIN RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3333
Mailing Address - Country:US
Mailing Address - Phone:850-785-7226
Mailing Address - Fax:
Practice Address - Street 1:625 W BALDWIN RD
Practice Address - Street 2:SUITE A
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3333
Practice Address - Country:US
Practice Address - Phone:850-785-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty