Healthcare Provider Details

I. General information

NPI: 1891962601
Provider Name (Legal Business Name): HIGH COUNTRY IMAGING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1987B S SHADY ST
MOUNTAIN CITY TN
37683-2021
US

IV. Provider business mailing address

1987B S SHADY ST
MOUNTAIN CITY TN
37683-2021
US

V. Phone/Fax

Practice location:
  • Phone: 423-727-0266
  • Fax: 423-727-0366
Mailing address:
  • Phone: 423-727-0266
  • Fax: 423-727-0366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberMXRT0000005135
License Number StateTN

VIII. Authorized Official

Name: MR. PAUL E SAJDAK
Title or Position: OWNER/PRESIDENT
Credential: RT (R)
Phone: 423-727-0266