Provider Demographics
NPI:1457397838
Name:NORTHERN CALIFORNIA IMAGING ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA IMAGING ASSOCIATES MEDICAL GROUP INC
Other - Org Name:WINE COUNTRY IMAGING MEDICAL GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-529-8280
Mailing Address - Street 1:PO BOX 4545
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-4545
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:2550 SISTER MARY COLUMBA DR
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4327
Practice Address - Country:US
Practice Address - Phone:530-529-8280
Practice Address - Fax:530-529-8279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094354Medicaid
CAGR0094351Medicaid
CAGR0094356Medicaid
CAGR0094352Medicaid
CAGR0094350Medicaid
CAGR0094353Medicaid
CAGR0094355Medicaid
CAZZZ26714ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAZZZ26716ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAGR0094356Medicaid
CAZZZ26713ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAGR0094351Medicaid
CAGR0094350Medicaid
CAZZZ26718ZMedicare PIN
CAZZZ26715ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER