Provider Demographics
NPI:1831109248
Name:IMPACT IMAGING, INC
Entity Type:Organization
Organization Name:IMPACT IMAGING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ELEONORA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGHDASHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-271-5055
Mailing Address - Street 1:4582 W JACQUELYN AVE
Mailing Address - Street 2:112
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6404
Mailing Address - Country:US
Mailing Address - Phone:559-271-5055
Mailing Address - Fax:559-271-5056
Practice Address - Street 1:4582 W JACQUELYN AVE
Practice Address - Street 2:112
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6404
Practice Address - Country:US
Practice Address - Phone:559-271-5055
Practice Address - Fax:559-271-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY38120Medicare UPIN