Great Lakes Medical Imaging Llc

LBN: Great Lakes Medical Imaging Llc
Great Lakes Medical Imaging Llc is an health care organization with primary practice located at 111 N Maplemere Rd Ste 120 , Williamsville NY 14221-3178. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as the primary health care specialty. Great Lakes Medical Imaging Llc can be contacted via phone (716) 836-4646, or through Pearsen, Kenneth D via phone (716) 836-4646.

Contact Information

Primary practice address
111 N Maplemere Rd Ste 120 Williamsville NY 14221-3178
Fax: (716) 836-4696
Website:
Authorized official contact:
Name: Pearsen, Kenneth D Doctor of Medicine (MD)

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X

Profile Details

NPI number 1861763005
LBN Legal business name Great Lakes Medical Imaging Llc
DBA Doing business as
Authorized official Pearsen, Kenneth D Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 19th, 2012
Last updated Aug 21st, 2023 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861763005 NPPES
New York MEDICAID 03428622

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