Provider Demographics
NPI:1013217769
Name:SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
Entity type:Organization
Organization Name:SYMPHONY DIAGNOSTIC SERVICES NO 1 LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-786-8015
Mailing Address - Street 1:930 RIDGEBROOK RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9390
Mailing Address - Country:US
Mailing Address - Phone:800-786-8015
Mailing Address - Fax:443-662-4230
Practice Address - Street 1:930 RIDGEBROOK RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152-9390
Practice Address - Country:US
Practice Address - Phone:800-786-8015
Practice Address - Fax:443-662-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000189649Medicaid
AZZ242004Medicaid
ID1013217769Medicaid
LA2374656Medicaid
AZ095566Medicaid
LA630001673OtherRAILROAD MEDICARE