Healthcare Provider Details

I. General information

NPI: 1063252328
Provider Name (Legal Business Name): PHYSICIANS CHOICE MOBILE IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4274 N BLACKSTONE AVE
FRESNO CA
93726-1900
US

IV. Provider business mailing address

4274 N BLACKSTONE AVE
FRESNO CA
93726-1900
US

V. Phone/Fax

Practice location:
  • Phone: 800-666-5323
  • Fax: 844-646-2020
Mailing address:
  • Phone: 800-666-5323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CASHMIR LUKE
Title or Position: CEO
Credential:
Phone: 800-666-5323