Provider Demographics
NPI:1861030074
Name:T-12 IMAGING LLC
Entity Type:Organization
Organization Name:T-12 IMAGING LLC
Other - Org Name:ASCEND IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:ERNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-595-8404
Mailing Address - Street 1:29201 TELEGRAPH RD STE L-01
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1301
Mailing Address - Country:US
Mailing Address - Phone:248-595-8404
Mailing Address - Fax:248-281-5155
Practice Address - Street 1:29201 TELEGRAPH RD STE L-01
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1301
Practice Address - Country:US
Practice Address - Phone:248-595-8404
Practice Address - Fax:248-996-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology