MEDICARE: PRESTIGE DIAGNOSTICS 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	2085U0001X	Diagnostic Ultrasound Physician	154319	MN

General Provider Information

NPI Number	:	1831580067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE DIAGNOSTICS INC

Provider Business Mailing Address
First Line	:	1157 HILLTOP DR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96003-3814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1157 HILLTOP DR
Second Line	:
City	:	REDDING
State	:	CA
Zip	:	96003-3814
Country	:	US
Telephone Number	:	530-691-1117
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRADY JONES
Credential	:
Telephone Number	:	530-227-5316

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	01/23/2019

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