Provider Demographics
NPI:1790128437
Name:THOMAS CROSBY
Entity Type:Organization
Organization Name:THOMAS CROSBY
Other - Org Name:MEDX-IMAGING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:X-RAY TECHNICIAN/EMT
Authorized Official - Phone:909-232-0056
Mailing Address - Street 1:1850 S WATERMAN AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-2877
Mailing Address - Country:US
Mailing Address - Phone:909-232-0056
Mailing Address - Fax:
Practice Address - Street 1:1850 S WATERMAN AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2877
Practice Address - Country:US
Practice Address - Phone:909-232-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHP 00079773261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology