MEDICARE: IMPERIAL VALLEY MEDICAL IMAGING SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00084116	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	165399	OTHER	CA	MAMMOGRAPHY CERTIFICATION
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205905353
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL VALLEY MEDICAL IMAGING SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 889
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91365-0889
Country	:	US
Telephone Number	:	818-597-3800
Fax Number	:	818-879-8272

Provider Business Practice Location Address
First Line	:	1600 S IMPERIAL AVE
Second Line	:	SUITE 17
City	:	EL CENTRO
State	:	CA
Zip	:	92243-4242
Country	:	US
Telephone Number	:	760-352-9808
Fax Number	:

Authorized Official
Title or Position	:	ACTIVE PARTNER OWNER MANAGER
Name	:	MR. JAMES ROBERT MCCALL
Credential	:	RT
Telephone Number	:	760-352-9808

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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Directions to “IMPERIAL VALLEY MEDICAL IMAGING SERVICES INC ” Practice Location

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