Provider Demographics
NPI:1912937202
Name:GENERAL IMAGING SERVICES, LLC
Entity Type:Organization
Organization Name:GENERAL IMAGING SERVICES, LLC
Other - Org Name:WELLPOINTE IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-997-9020
Mailing Address - Street 1:1002 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3402
Mailing Address - Country:US
Mailing Address - Phone:810-985-9551
Mailing Address - Fax:810-985-5444
Practice Address - Street 1:1701 SOUTH BLVD E
Practice Address - Street 2:SUITE B50
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6122
Practice Address - Country:US
Practice Address - Phone:248-997-9020
Practice Address - Fax:248-997-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P22220Medicare ID - Type Unspecified