Organization Active NPI

Bertrand Diagnostic Imaging and Breast Center, Inc.

  • Specialist
  • Greensboro, NC
National Provider Identifier
1841281631
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
20236 Issued in NC
Legal business name
BERTRAND DIAGNOSTIC IMAGING AND BREAST CENTER, INC.
Practice address
1126 N Church St
Suite 103
Greensboro, NC 27401-1000
Phone
(336) 379-0941
Fax
(336) 379-7997
NPI assigned
Nov 2, 2005
Last updated
May 15, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

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

Authorized official

Name
Ms. Eileen Kanewske
Title
Director PT. Accounts
Phone
(512) 340-8114

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 20236 NC Primary

Addresses

Primary practice location

1126 N Church St
Suite 103
Greensboro, NC 27401-1000

Mailing address

PO Box 6730565
Dallas, TX 75373-0001
Phone (866) 613-5807

Other identifiers 2

IdentifierTypeStateIssuer
890270AMedicaidNC
0270AOtherNCBLUE CROSS PROVIDER NUMBE

National Provider Directory

National Provider Directory

Locations

3192 Walden Ln
Burlington, NC 27215
Phone (336) 538-1169

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210809600000",
    "number": "1841281631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6730565",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753730001",
            "telephone_number": "866-613-5807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 N CHURCH ST",
            "address_2": "SUITE 103",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274011000",
            "telephone_number": "336-379-0941",
            "fax_number": "336-379-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERTRAND DIAGNOSTIC IMAGING AND BREAST CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2008-05-15",
        "status": "A",
        "authorized_official_last_name": "KANEWSKE",
        "authorized_official_first_name": "EILEEN",
        "authorized_official_title_or_position": "DIRECTOR PT. ACCOUNTS",
        "authorized_official_telephone_number": "512-340-8114",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "20236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890270A",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "0270A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.