Basic Information
| Provider Information | |||||||||
| NPI: | 1417906983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TROLLEY SQUARE OPEN MRI AND IMAGING CENTER, LLC | ||||||||
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| OtherOrganizationName: | BANCROFT PARKWAY OPEN MRI & IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 N BANCROFT PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198052690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024725555 | ||||||||
| FaxNumber: | 3024729998 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 N BANCROFT PKWY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198052690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024725555 | ||||||||
| FaxNumber: | 3024729998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 10/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROLLINS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 3022462000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 2004210715 | DE | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.