Provider Demographics
NPI:1700923349
Name:SPORTS MEDICINE MRI
Entity Type:Organization
Organization Name:SPORTS MEDICINE MRI
Other - Org Name:SM MRI
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-563-3136
Mailing Address - Street 1:3727 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-5410
Mailing Address - Country:US
Mailing Address - Phone:415-563-3136
Mailing Address - Fax:415-563-3301
Practice Address - Street 1:3727 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-5410
Practice Address - Country:US
Practice Address - Phone:415-563-3136
Practice Address - Fax:415-563-3301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28863ZMedicare ID - Type Unspecified