Provider Demographics
NPI:1023015252
Name:MEDICAL INSIGHTS DIAGNOSTIC
Entity Type:Organization
Organization Name:MEDICAL INSIGHTS DIAGNOSTIC
Other - Org Name:MIDXC-OPEN MRI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-691-6432
Mailing Address - Street 1:1401 WILLOW PASS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7982
Mailing Address - Country:US
Mailing Address - Phone:925-691-6432
Mailing Address - Fax:925-691-6434
Practice Address - Street 1:1401 WILLOW PASS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7982
Practice Address - Country:US
Practice Address - Phone:925-691-6432
Practice Address - Fax:925-691-6434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31703ZMedicare ID - Type UnspecifiedIDTF PROVIDER NUMBER