Provider Demographics
NPI:1487012142
Name:CORRECTIONAL MEDICAL IMAGING, INC.
Entity Type:Organization
Organization Name:CORRECTIONAL MEDICAL IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-659-4186
Mailing Address - Street 1:2713 INDUSTRIAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6705
Mailing Address - Country:US
Mailing Address - Phone:573-634-7155
Mailing Address - Fax:573-634-3349
Practice Address - Street 1:1001 SOUTHWEST BLVD STE C
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2501
Practice Address - Country:US
Practice Address - Phone:573-634-7155
Practice Address - Fax:573-634-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7J082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty