Provider Demographics
NPI:1902864366
Name:MEDICAL IMAGING CONSULTANTS LLP
Entity Type:Organization
Organization Name:MEDICAL IMAGING CONSULTANTS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-918-6525
Mailing Address - Street 1:1602 PINE TREE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3273
Mailing Address - Country:US
Mailing Address - Phone:903-759-8886
Mailing Address - Fax:903-247-0222
Practice Address - Street 1:700 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5580
Practice Address - Country:US
Practice Address - Phone:903-315-2072
Practice Address - Fax:903-247-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX023218301OtherCIDC
TX093656901OtherCOUNTY AGENCY
TX093656901Medicaid
TXDA2958OtherTRAVELERS MEDICARE
TX00K61QOtherBLUE CROSS BLUE SHIELD TX
TX015922OtherTX KIDNEY HEALTH
TX093656901OtherCHIP PROGRAM