Provider Demographics
NPI:1023439650
Name:JCAT IMAGING SERVICES
Entity type:Organization
Organization Name:JCAT IMAGING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:916-821-7919
Mailing Address - Street 1:PO BOX 1803
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-1803
Mailing Address - Country:US
Mailing Address - Phone:916-821-7919
Mailing Address - Fax:
Practice Address - Street 1:311 LOS LENTES RD SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9224
Practice Address - Country:US
Practice Address - Phone:575-322-8175
Practice Address - Fax:505-565-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-28
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM43122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty