Provider Demographics
NPI:1053143487
Name:SHIELDS AND ATRIUS HEALTH PET-CT AT DEDHAM LLC
Entity type:Organization
Organization Name:SHIELDS AND ATRIUS HEALTH PET-CT AT DEDHAM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PEC
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORSFALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-258-4738
Mailing Address - Street 1:700 CONGRESS ST STE 204
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-0928
Mailing Address - Country:US
Mailing Address - Phone:866-258-4738
Mailing Address - Fax:888-662-4700
Practice Address - Street 1:40 ALLIED DR STE 112-A
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-6146
Practice Address - Country:US
Practice Address - Phone:866-258-4738
Practice Address - Fax:888-662-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile