Eastside Diagnostics LLC

Primary specialty

Mobile Radiology Clinic/CenterTaxonomy code 261QR0208X

Legal business name

EASTSIDE DIAGNOSTICS LLC

Practice address

25100 Kelly Rd Ste B
Roseville, MI 48066-4910

Phone

(248) 262-7379

NPI assigned

Aug 19, 2020

Organization subpart

Yes

Parent organization

MAXIM L.L.C.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Watson, NP-C

Title

Administrator

Phone

(248) 709-7072

Specialties & licenses 1

Addresses

Other names 1

• Maxim MRI Doing business as

Part of

Maxim MRI LLC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rajeev Jolly

  • Durable Medical Equipment & Medical Supplies
  • New Hudson, MI
  • NPI 1174183149
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597795200000",
    "number": "1225640329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22000 GREENFIELD RD",
            "city": "OAK PARK",
            "state": "MI",
            "postal_code": "482372500",
            "telephone_number": "248-709-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25100 KELLY RD STE B",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480664910",
            "telephone_number": "248-262-7379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE DIAGNOSTICS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAXIM L.L.C.",
        "enumeration_date": "2020-08-19",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "248-709-7072",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "261QR0208X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mobile",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maxim MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eastlake Pediatrics PC
• Eastland Diagnostic PC
• Jeffrey Waldemar Easton II, D.D.S.
• Eastside Cardiovascular Medicine
• Eastside Cardiovascular Medicine, P.C.
• Ecg Scanning & Medical Services Inc
• Latonya Nicole Edwards-Jones
• Robert David Edwards, MD
• Abdul R Effendi, MD
• Valerie Ann Efros, MD

• Mobile Radiology Clinic/Center in Roseville, MI
• Providers in Roseville, MI by specialty
• Mobile Radiology Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.