Basic Information
| Provider Information | |||||||||
| NPI: | 1689613929 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA ADVANCED IMAGING MEDICAL ASSOC., INC. | ||||||||
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| OtherOrganizationName: | NATIONAL ORTHOPEDIC IMAGING ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6102 | ||||||||
| Address2: | |||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949486102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4158843418 | ||||||||
| FaxNumber: | 4158833406 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 BON AIR RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | LARKSPUR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949391141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159275300 | ||||||||
| FaxNumber: | 4159275242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOYE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | KELLY | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4158843448 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | CI2439 | 01 | CA | RAILROAD MEDICARE | OTHER | GR000314D | 05 | CA | MEDICAID |