Provider Demographics
NPI:1952334070
Name:ORTHOPEDIC IMAGING CENTER LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-557-1600
Mailing Address - Street 1:PO BOX 8820
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92375-2020
Mailing Address - Country:US
Mailing Address - Phone:909-557-1690
Mailing Address - Fax:909-557-1735
Practice Address - Street 1:1901 W LUGONIA AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374
Practice Address - Country:US
Practice Address - Phone:909-557-1690
Practice Address - Fax:909-557-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ31558Z261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31558ZMedicare ID - Type Unspecified