Provider Demographics
NPI:1184174831
Name:COMMUNITY HEALTH IMAGING CENTERS
Entity type:Organization
Organization Name:COMMUNITY HEALTH IMAGING CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LETHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-425-2737
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:SELDOVIA
Mailing Address - State:AK
Mailing Address - Zip Code:99663-0206
Mailing Address - Country:US
Mailing Address - Phone:907-234-7825
Mailing Address - Fax:
Practice Address - Street 1:259 SELDOVIA STREET
Practice Address - Street 2:
Practice Address - City:SELDOVIA
Practice Address - State:AK
Practice Address - Zip Code:99663
Practice Address - Country:US
Practice Address - Phone:907-234-7825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY HEALTH IMAGING CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1036864261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography