Provider Demographics
NPI:1073277125
Name:EVOLVED DIAGNOSTIC IMAGING PC
Entity Type:Organization
Organization Name:EVOLVED DIAGNOSTIC IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-414-8640
Mailing Address - Street 1:500 CAPITOL MALL STE 2350
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4760
Mailing Address - Country:US
Mailing Address - Phone:916-414-8640
Mailing Address - Fax:
Practice Address - Street 1:500 CAPITOL MALL STE 2350
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-4760
Practice Address - Country:US
Practice Address - Phone:916-414-8640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier