Provider Demographics
NPI:1982649158
Name:NEW ENGLAND MOLECULAR IMAGING LLC
Entity Type:Organization
Organization Name:NEW ENGLAND MOLECULAR IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGMORE GRUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:100 BAYVIEW CIRCLE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2984
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:300 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7007
Practice Address - Country:US
Practice Address - Phone:207-795-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME01601261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7695348OtherAETNA
ME129019400OtherU.S. DEPT OF LABOR OWCP
ME166060000Medicaid
ME043913OtherANTHEM BLUE CROSS
ME800942OtherHARVARD PILGRIM HLTH CARE
MENE327075Medicare ID - Type UnspecifiedIDTF PART B
MEP00008433Medicare ID - Type UnspecifiedRAILROAD