Provider Demographics
NPI:1760701387
Name:HORIZON IMAGING LLC
Entity Type:Organization
Organization Name:HORIZON IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-889-4580
Mailing Address - Street 1:1695 W 12 MILE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-2182
Mailing Address - Country:US
Mailing Address - Phone:248-298-8999
Mailing Address - Fax:
Practice Address - Street 1:1695 W 12 MILE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-2182
Practice Address - Country:US
Practice Address - Phone:248-298-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-21
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)