Healthcare Provider Details

I. General information

NPI: 1497734859
Provider Name (Legal Business Name): VISTA DIAGNOSTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MCCABE DR
RENO NV
89511-5991
US

IV. Provider business mailing address

25 MCCABE DR
RENO NV
89511
US

V. Phone/Fax

Practice location:
  • Phone: 775-852-5444
  • Fax: 775-852-5451
Mailing address:
  • Phone: 775-852-5444
  • Fax: 775-356-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MARK W CRAWFORD
Title or Position: CEO
Credential:
Phone: 775-356-9393