Basic Information
| Provider Information | |||||||||
| NPI: | 1639111958 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18201 VON KARMAN AVE STE 600 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926121176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005443215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2033 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ATHOL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 013313535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9782493511 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 12/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | LARKIN | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8005443215 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/30/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0208X | 4380 | MA | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mobile |
ID Information
| ID | Type | State | Issuer | Description | 711456 | 01 | MA | TUFTS/SECURE HORIZONS | OTHER | 102330300 | 01 | MA | U.S. DEPT OF LABOR OWCP | OTHER | 985455 | 01 | MA | NETWORK HEALTH | OTHER | 0113178 | 01 | MA | AETNA | OTHER | 603303 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | 1530259 | 05 | MA | MEDICAID | 17687 | 01 | MA | HEALTH NEW ENGLAND | OTHER | 0418278 | 01 | MA | CIGNA / HEALTHSOURCE | OTHER | 000000006899 | 01 | MA | BOSTON MC HEALTHNET PLAN | OTHER | 017769 | 01 | MA | BCBS | OTHER | 65689 | 01 | MA | FALLON | OTHER | 0008340 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 740694 | 01 | MA | CONNECTICARE | OTHER |