IMAGING HEALTHCARE SPECIALISTS MEDICAL GROUP, INC.

Provider Demographics

• NPI: 1750498093
• Name: IMAGING HEALTHCARE SPECIALISTS MEDICAL GROUP, INC.
• Entity type: Organization
• Organization Name: IMAGING HEALTHCARE SPECIALISTS MEDICAL GROUP, INC.
• Authorized Official - Title/Position: PRESIDENT & CEO
• Authorized Official - First Name: THOMAS
• Authorized Official - Middle Name: D
• Authorized Official - Last Name: CLEARY
• Authorized Official - Phone: 866-558-4320
• Mailing Address - Street 1: FILE 1317 1801 W OLYMPIC BLVD
• Mailing Address - City: PASADENA
• Mailing Address - State: CA
• Mailing Address - Zip Code: 91199-1317
• Mailing Address - Country: US
• Mailing Address - Phone: 888-927-8018
• Mailing Address - Fax: 800-508-4751
• Practice Address - Street 1: 6256 GREENWICH DR
• Practice Address - Street 2: SUITE 150
• Practice Address - City: SAN DIEGO
• Practice Address - State: CA
• Practice Address - Zip Code: 92122-5941
• Practice Address - Country: US
• Practice Address - Phone: 866-558-4320
• Practice Address - Fax: 619-294-8399
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-08-24
• Last Update Date: 2013-10-29

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology	Group - Multi-Specialty
No	207U00000X	Allopathic & Osteopathic Physicians	Nuclear Medicine		Group - Multi-Specialty
No	2085R0204X	Allopathic & Osteopathic Physicians	Radiology	Vascular & Interventional Radiology	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
CA	GR0103681	Medicaid
CA	GR0103684	Medicaid
CA	GR010368A	Medicaid
CA	GR010368C	Medicaid
CA	GR0103683	Medicaid
CA	GR0103680	Medicaid
CA	GR0103685	Medicaid
CA	GR0103687	Medicaid
CA	GR010368B	Medicaid
CA	GR0103686	Medicaid
CA	GR0103688	Medicaid
CA	GR0103689	Medicaid
CA	GR0103682	Medicaid
CA	GR010368D	Medicaid
CA	GR010368A	Medicaid
CA	GR010368D	Medicaid
CA	GR0103683	Medicaid
CA	W20317A	Medicare PIN
CA	ZZZ04128Z	Medicare PIN