Provider Demographics
NPI:1861854192
Name:CONCORDIA IMAGING
Entity Type:Organization
Organization Name:CONCORDIA IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-842-2313
Mailing Address - Street 1:8159 CALLE CONCORDIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-1551
Mailing Address - Country:US
Mailing Address - Phone:787-842-2313
Mailing Address - Fax:787-842-4218
Practice Address - Street 1:8159 CALLE CONCORDIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1551
Practice Address - Country:US
Practice Address - Phone:787-842-2313
Practice Address - Fax:787-842-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6655261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography