Provider Demographics
NPI:1053353599
Name:NORTH SHORE MAGNETIC IMAGING CENTER
Entity type:Organization
Organization Name:NORTH SHORE MAGNETIC IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-573-3116
Mailing Address - Street 1:68 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1605
Mailing Address - Country:US
Mailing Address - Phone:978-532-8960
Mailing Address - Fax:978-532-0633
Practice Address - Street 1:68 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1605
Practice Address - Country:US
Practice Address - Phone:978-532-8960
Practice Address - Fax:978-532-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4385261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA29480OtherAETNA
MA018169OtherBC/BS OF MA
MA2226830784OtherCHAMPUS/TRICARE
MA605118OtherHARVARD PILGRIM
MA0007590OtherNEIGHBORHOOD HEALTH
MA1530496Medicaid
MA1600036OtherUNITED HEALTHCARE
MD709656OtherTUFTS HEALTH
MA31612OtherFALLON HEALTHCARE
MA2226830784OtherCHAMPUS/TRICARE
MA31612OtherFALLON HEALTHCARE
MA=========OtherCIGNA
MA=========OtherCIGNA