=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063252328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIANS CHOICE MOBILE IMAGING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2024
-----------------------------------------------------
Last Update Date | 05/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4274 N BLACKSTONE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93726-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-666-5323
-----------------------------------------------------
Fax | 844-646-2020
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4274 N BLACKSTONE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93726-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-666-5323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CASHMIR LUKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 800-666-5323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0207X
-----------------------------------------------------
Taxonomy Name | Mobile Mammography Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 335V00000X
-----------------------------------------------------
Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------