Provider Demographics
NPI:1801873708
Name:MEDICAL IMAGING CONSULTANTS, PC
Entity type:Organization
Organization Name:MEDICAL IMAGING CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-393-7984
Mailing Address - Street 1:4300 N ACCESS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-3812
Mailing Address - Country:US
Mailing Address - Phone:423-826-1276
Mailing Address - Fax:423-826-1290
Practice Address - Street 1:1801 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2201
Practice Address - Country:US
Practice Address - Phone:931-393-7984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3387294Medicare ID - Type Unspecified