Provider Demographics
NPI:1629434881
Name:GRANDVIEW IMAGING, LLC
Entity type:Organization
Organization Name:GRANDVIEW IMAGING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-689-1691
Mailing Address - Street 1:PO BOX 745973
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3570 GRANDVIEW PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2064
Practice Address - Country:US
Practice Address - Phone:205-977-2274
Practice Address - Fax:205-977-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology