Provider Demographics
NPI:1578529756
Name:SOLANO IMAGING MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SOLANO IMAGING MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRONK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-261-7880
Mailing Address - Street 1:PO BOX 3222
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0293
Mailing Address - Country:US
Mailing Address - Phone:707-261-7804
Mailing Address - Fax:707-256-3508
Practice Address - Street 1:1200 B GALE WILSON BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3552
Practice Address - Country:US
Practice Address - Phone:707-646-5100
Practice Address - Fax:707-429-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046111Medicaid
CAGR0046112Medicaid
CAGR0046110Medicaid
CAGR0046115Medicaid
CAGR0046115Medicaid
CAMMM00370MMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAZZZ33720ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAGR0046112Medicaid
CAGR0046111Medicaid