EASTSIDE DIAGNOSTICS LLC (NPI# 1225640329) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225640329 |
| Entity Type | Organization |
| Organization Name | EASTSIDE DIAGNOSTICS LLC |
| Practice Address |
25100 Kelly Rd Ste B Roseville MI 48066-4910 |
| Mailing Address |
22000 Greenfield Rd Oak Park MI 48237-2500 |
| Practice Telephone | 2482627379 |
| Mailing Telephone | 2487097072 |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2020-08-19 |
| Authorized Official Name | JENNIFER WATSON (ADMINISTRATOR) |
| Authorized Official Telephone | 2487097072 |
| Authorized Official Credential | NP-C |
| Is Organization Subpart | Y |
| Parent Organization Name | MAXIM L.L.C. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0208X |
Clinic/Center Specialization: Radiology, Mobile |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Maxim MRI | Doing Business As Name - Organization |
| Street Address |
25100 KELLY RD STE B |
| City | ROSEVILLE |
| State | MI |
| Zip Code | 48066-4910 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437761400 | Louay Mansour Dds PC | Dentist | 27845 Gratiot Avenue, Roseville, MI 48066 | 2020-08-20 |
| 1558911842 | Jomy Jose | Nurse Practitioner | 25719 Salem St, Roseville, MI 48066 | 2019-09-18 |
| 1053963033 | Convenient Rv PC | Dentist | 19551 E. 10 Mile Rd, Roseville, MI 48066 | 2019-07-10 |
| 1063914539 | Colleen Meriweather | Registered Nurse | 27300 Spruce, Rosevilel, MI 48066 | 2018-03-01 |
| 1326565789 | Renee Suzette Hoelzeman | Nurse Practitioner | 18472 Meier St, Roseville, MI 48066 | 2017-08-27 |
| 1225561400 | Eugenia Dillard | Counselor | 28351 Gratiot Ave., Suite 3, Roseville, MI 48066 | 2017-04-05 |
| 1932651338 | Julie Plichota | Physical Therapist | 31120 Gratiot Ave, Roseville, MI 48066 | 2016-11-01 |
| 1699221325 | Jaquenta Glasker | Technician, Other | 26778 Rosewood, Roseville, MI 48066 | 2016-09-01 |
| 1609296144 | Peter Jajou | Dermatology | 18285 E 10 Mile Rd Ste 130, Roseville, MI 48066 | 2014-04-23 |
| 1619393899 | Katherine Michelle Johnson | Obstetrics & Gynecology | 29751 Little Mack Ave Ste B, Roseville, MI 48066 | 2014-03-11 |
| Find all providers in zip 48066 | ||||
| Taxonomy Code | 261QR0208X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology, Mobile |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114579315 | Ami LLC | Clinic/Center | 4132 Schaefer Rd, Dearborn, MI 48126-3683 | 2019-07-09 |
| 1982997078 | Affiliated Diagnostic of Oakland LLC | Clinic/Center | 26550 Northwestern Hwy, Southfield, MI 48076-3741 | 2011-05-23 |
| 1629394457 | Great Lakes Musculoskeletal Ultrasound Inc. | Clinic/Center | 6928 Coleman St, Dearborn, MI 48126-1776 | 2010-04-19 |
| 1265668057 | Digital Diagnostic Imaging | Clinic/Center | 2067 N Opdyke Rd, Auburn Hills, MI 48326-2432 | 2009-06-08 |
| 1164609202 | Sonopros, Inc. | Clinic/Center | 6051 Kingsfield Dr, West Bloomfield, MI 48322-1467 | 2008-01-30 |
| 1538349006 | Synergy Mobile Imaging LLC | Clinic/Center | 3591 Schumann Road Unit #13, Mobile Idtf, Bay City, MI 48706 | 2007-11-13 |
| 1447477617 | Alliance Healthcare Services Inc | Clinic/Center | 4599 Towne Centre Rd, Saginaw, MI 48604-2804 | 2007-04-19 |
| 1386708113 | Complete Diagnostic Services Inc | Clinic/Center | 2289 Star Ct, Rochester Hills, MI 48309-3625 | 2006-12-19 |
| 1336704311 | Genesis Md Diagnostic Imaging PC | Clinic/Center | 8560 N Silvery Ln Ste 101, Dearborn Heights, MI 48127-4516 | 2019-05-06 |
| 1588190086 | Maxim Mri L.L.C. | Clinic/Center | 23832 Southfield Rd, Southfield, MI 48075-8000 | 2017-05-04 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EASTSIDE DIAGNOSTICS LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.