Basic Information
| Provider Information | |||||||||
| NPI: | 1801873708 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL IMAGING CONSULTANTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 N ACCESS RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374153812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238261276 | ||||||||
| FaxNumber: | 4238261290 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 N JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | TULLAHOMA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373882201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313937984 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
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| AuthorizedOfficialLastName: | BIRDWELL | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9313937984 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.