Basic Information
| Provider Information | |||||||||
| NPI: | 1801851340 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST BAY MEDICAL IMAGING LLC | ||||||||
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| OtherOrganizationName: | INSIGHT IMAGING - EAST BAY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 404166 | ||||||||
| Address2: | LEGAL DEPT | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303844166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9492826000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2242 CAMINO RAMON | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253270015 | ||||||||
| FaxNumber: | 9253270095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 05/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | DRAZBA | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP & CHIEF ACCOUNTING OFCR | ||||||||
| AuthorizedOfficialTelephone: | 9492826000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | Y | Laboratories | Physiological Laboratory |
No ID Information.