Provider Demographics
NPI:1982777348
Name:TRI-COUNTY MEDICAL IMAGING SERVICES,INC
Entity Type:Organization
Organization Name:TRI-COUNTY MEDICAL IMAGING SERVICES,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:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:590 W PUTNAM AVE
Practice Address - Street 2:SUITE 2 B
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3257
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 Licenses
StateLicense IDTaxonomies
CA054353261QR0200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Not Answered261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG409810Medicaid
CAOOG409811Medicaid
CAOOG409810Medicaid
CA8598418Medicare UPIN