Provider Demographics
NPI:1265480099
Name:PACIFIC IMAGING CONSULTANTS, A MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PACIFIC IMAGING CONSULTANTS, A MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MALCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-274-4950
Mailing Address - Street 1:411 30TH ST
Mailing Address - Street 2:#508
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3310
Mailing Address - Country:US
Mailing Address - Phone:925-274-4950
Mailing Address - Fax:925-274-4975
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:#508
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3310
Practice Address - Country:US
Practice Address - Phone:925-274-4950
Practice Address - Fax:925-274-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty