Provider Demographics
NPI:1245774587
Name:SPECIALIZED IMAGING
Entity type:Organization
Organization Name:SPECIALIZED IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:562-706-1034
Mailing Address - Street 1:PO BOX 5685
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-5685
Mailing Address - Country:US
Mailing Address - Phone:562-706-1034
Mailing Address - Fax:
Practice Address - Street 1:117 NAVAJO, UNIT 3
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:562-706-1034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117741335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier