Provider Demographics
NPI:1801851340
Name:EAST BAY MEDICAL IMAGING LLC
Entity Type:Organization
Organization Name:EAST BAY MEDICAL IMAGING LLC
Other - Org Name:INSIGHT IMAGING - EAST BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP & CHIEF ACCOUNTING OFCR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DRAZBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-6000
Mailing Address - Street 1:PO BOX 404166
Mailing Address - Street 2:LEGAL DEPT
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4166
Mailing Address - Country:US
Mailing Address - Phone:949-282-6000
Mailing Address - Fax:
Practice Address - Street 1:2242 CAMINO RAMON
Practice Address - Street 2:STE 100
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1352
Practice Address - Country:US
Practice Address - Phone:925-327-0015
Practice Address - Fax:925-327-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ27452ZMedicare PIN