Healthcare Provider Details

I. General information

NPI: 1982777348
Provider Name (Legal Business Name): TRI-COUNTY MEDICAL IMAGING SERVICES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 W PUTNAM AVE SUITE 2 B
PORTERVILLE CA
93257-3257
US

IV. Provider business mailing address

PO BOX 8613
PORTERVILLE CA
93258-8613
US

V. Phone/Fax

Practice location:
  • Phone: 559-782-1973
  • Fax: 559-782-1976
Mailing address:
  • Phone: 559-782-1973
  • Fax: 559-782-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number054353
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number054353
License Number StateCA

VIII. Authorized Official

Name: MS. ELLA JACKSON
Title or Position: PRESIDENT
Credential:
Phone: 559-782-1973