Provider Demographics
NPI:1598700171
Name:VALLEY MRI CENTER
Entity Type:Organization
Organization Name:VALLEY MRI CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:AUBREY
Authorized Official - Last Name:FEDERAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-467-1000
Mailing Address - Street 1:546 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5525
Mailing Address - Country:US
Mailing Address - Phone:209-467-1000
Mailing Address - Fax:209-467-7335
Practice Address - Street 1:546 E PINE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5525
Practice Address - Country:US
Practice Address - Phone:209-467-1000
Practice Address - Fax:209-467-7335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C359051Medicaid
CAZZZ29563ZMedicare PIN