Provider Demographics
NPI:1700597481
Name:SPIRIT IMAGING CENTER LLC
Entity Type:Organization
Organization Name:SPIRIT IMAGING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TYAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-448-8698
Mailing Address - Street 1:501 SILVERSIDE RD STE 135
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-1377
Mailing Address - Country:US
Mailing Address - Phone:302-448-8698
Mailing Address - Fax:302-269-3995
Practice Address - Street 1:501 SILVERSIDE RD STE 135
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19809-1377
Practice Address - Country:US
Practice Address - Phone:302-448-8698
Practice Address - Fax:302-397-2828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)