Provider Demographics
NPI:1396217972
Name:TK IMAGING PC
Entity type:Organization
Organization Name:TK IMAGING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TYRE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JONES
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:614-210-1885
Mailing Address - Street 1:PO BOX 775953
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5953
Mailing Address - Country:US
Mailing Address - Phone:614-210-1885
Mailing Address - Fax:614-210-1886
Practice Address - Street 1:2770 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1141
Practice Address - Country:US
Practice Address - Phone:614-210-1885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography