Provider Demographics
NPI:1457424814
Name:PARTNERS MEDICAL IMAGING GROUP,INC
Entity Type:Organization
Organization Name:PARTNERS MEDICAL IMAGING GROUP,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOMER-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT,RDMS
Authorized Official - Phone:559-782-1973
Mailing Address - Street 1:PO BOX 8613
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93258-8613
Mailing Address - Country:US
Mailing Address - Phone:559-782-1973
Mailing Address - Fax:559-782-1976
Practice Address - Street 1:250 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3428
Practice Address - Country:US
Practice Address - Phone:559-782-1973
Practice Address - Fax:559-782-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG409810Medicaid
CA8598418Medicare UPIN