Provider Demographics
NPI:1780724955
Name:TOWN & COUNTRY DIAGNOSTICS
Entity type:Organization
Organization Name:TOWN & COUNTRY DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-734-0822
Mailing Address - Street 1:PO BOX 6404
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-6404
Mailing Address - Country:US
Mailing Address - Phone:559-734-0822
Mailing Address - Fax:559-734-4383
Practice Address - Street 1:6125 W LAURA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5558
Practice Address - Country:US
Practice Address - Phone:559-734-0822
Practice Address - Fax:559-734-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFAC57539335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24171ZMedicare ID - Type UnspecifiedPROVIDER NUMBER
CABBB33473BMedicare ID - Type UnspecifiedSUBMITTER ID NUMBER