Provider Demographics
NPI:1356223879
Name:THE IMAGING CENTER PC
Entity type:Organization
Organization Name:THE IMAGING CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:LABINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-617-2623
Mailing Address - Street 1:710 KENMOOR AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2302
Mailing Address - Country:US
Mailing Address - Phone:616-617-2623
Mailing Address - Fax:
Practice Address - Street 1:710 KENMOOR AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2302
Practice Address - Country:US
Practice Address - Phone:616-617-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE IMAGING CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty