Provider Demographics
NPI:1639349814
Name:GLENDALE MEDICAL IMAGING ASSOCIATES INC
Entity Type:Organization
Organization Name:GLENDALE MEDICAL IMAGING ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-247-2095
Mailing Address - Street 1:200 N MARYLAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4262
Mailing Address - Country:US
Mailing Address - Phone:818-247-2095
Mailing Address - Fax:818-241-7278
Practice Address - Street 1:200 N MARYLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4262
Practice Address - Country:US
Practice Address - Phone:818-247-2095
Practice Address - Fax:818-241-7278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty