Provider Demographics
NPI:1669868212
Name:GEMINI IMAGING GROUP, INC
Entity type:Organization
Organization Name:GEMINI IMAGING GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:410-972-4707
Mailing Address - Street 1:1745 SHEA CENTER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-1540
Mailing Address - Country:US
Mailing Address - Phone:720-344-4867
Mailing Address - Fax:720-344-4801
Practice Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3273
Practice Address - Country:US
Practice Address - Phone:410-972-4707
Practice Address - Fax:410-972-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD120204335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier