Clean Image

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

22D2047480 Issued in MA

Legal business name

CLEAN IMAGE

Practice address

10 Wendell Avenue Ext
Suite 105
Pittsfield, MA 01201-6283

Phone

(413) 464-7521

Fax

(877) 208-8430

NPI assigned

Mar 8, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Brian Hicks, MLSNPI 1356689152

Title

President/Laboratory Director

Phone

(413) 464-7521

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Brian Hicks, MLS

  • Medical Technologist
  • Pittsfield, MA
  • NPI 1356689152

  Clinical Medical Laboratory

  NPD (past) Authorized official

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

{
    "created_epoch": "1362700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362700800000",
    "number": "1497096960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WENDELL AVENUE EXT",
            "address_2": "SUITE 105",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012016283",
            "telephone_number": "413-464-7521",
            "fax_number": "877-208-8430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WENDELL AVENUE EXT",
            "address_2": "SUITE 105",
            "city": "PITTSFIELD",
            "state": "MA",
            "postal_code": "012016283",
            "telephone_number": "413-464-7521",
            "fax_number": "877-208-8430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLEAN IMAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-08",
        "last_updated": "2013-03-08",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "PRESIDENT/LABORATORY DIRECTOR",
        "authorized_official_telephone_number": "413-464-7521",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MLS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MA",
            "license": "22D2047480",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Clark, NP
• Vanessa Marie Clark, BA
• Richard F Clarke, M.D.
• Tonique Clay
• Hannah Clayton, RD
• Meghan Clements
• Craig Gibbons Clemow, PSYCHOLOGIST
• Clinical and Support Options
• Clinical and Support Options
• Coastal CBT New England, LLC

• Clinical Medical Laboratory in Pittsfield, MA
• Providers in Pittsfield, MA by specialty
• Clinical Medical Laboratory in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2013; 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.