Healthcare Provider Details

I. General information

NPI: 1912935099
Provider Name (Legal Business Name): MRI IMAGING CENTER OF FRESNO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W SHAW AVE
FRESNO CA
93704-2817
US

IV. Provider business mailing address

108 W SHAW AVE
FRESNO CA
93704-2817
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-2888
  • Fax: 559-266-2887
Mailing address:
  • Phone: 559-226-2888
  • Fax: 559-266-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number9839082
License Number StateCA

VIII. Authorized Official

Name: MR. EDWARD M FRENCH
Title or Position: BILLING MANAGER
Credential:
Phone: 559-226-2888