Provider Demographics
NPI:1952335135
Name:OLSON IMAGING LLC
Entity Type:Organization
Organization Name:OLSON IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCINTRYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-479-0461
Mailing Address - Street 1:2424 N GRAND AVE
Mailing Address - Street 2:STE A1
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-479-0461
Mailing Address - Fax:714-479-0463
Practice Address - Street 1:631 N STEPHANIE ST
Practice Address - Street 2:STE 423
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2633
Practice Address - Country:US
Practice Address - Phone:702-340-7111
Practice Address - Fax:714-479-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV102307Medicare ID - Type UnspecifiedNORIDIAN