Provider Demographics
NPI:1164959086
Name:JAMES R. DAVIS
Entity Type:Organization
Organization Name:JAMES R. DAVIS
Other - Org Name:SPECIALIZED IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:970-279-1205
Mailing Address - Street 1:PO BOX 5685
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-5685
Mailing Address - Country:US
Mailing Address - Phone:970-279-1205
Mailing Address - Fax:
Practice Address - Street 1:117 NAVAJO TRAIL DR STE V
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147-9033
Practice Address - Country:US
Practice Address - Phone:970-279-1205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1177412471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Single Specialty