Great Lakes Teleradiology Ventures LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

193400000X Issued in MI

Legal business name

GREAT LAKES TELERADIOLOGY VENTURES LLC

Practice address

1165 S Linden Rd
Ste. B
Flint, MI 48532

Phone

(810) 600-6300

Fax

(810) 600-6222

NPI assigned

May 27, 2009

Organization subpart

No

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

Authorized official

Name

Amy Saad

Title

Credentialer

Phone

(313) 655-4544

Specialties & licenses 1

Addresses

Other names 1

• Great Lakes Teleradiology Ventures PLLC Former legal business name

Locations

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

{
    "created_epoch": "1243382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406678400000",
    "number": "1457586083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1165 S LINDEN RD",
            "address_2": "STE. B",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48532",
            "telephone_number": "810-600-6300",
            "fax_number": "810-600-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1165 S LINDEN RD",
            "address_2": "STE. B",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "48532",
            "telephone_number": "810-600-6300",
            "fax_number": "810-600-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES TELERADIOLOGY VENTURES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-27",
        "last_updated": "2014-07-30",
        "status": "A",
        "authorized_official_last_name": "SAAD",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "CREDENTIALER",
        "authorized_official_telephone_number": "313-655-4544"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "193400000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Lakes Teleradiology Ventures PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Specialist in Flint, MI
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• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; 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.