=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689241150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIONAL IMAGING, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2021
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6412 LAUREL AVE
-----------------------------------------------------
City | MOUNTAIN MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93240-9529
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-379-2681
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 9099
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75608-9099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-663-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | ALBERT J COOK II
-----------------------------------------------------
Credential | MD, MBA
-----------------------------------------------------
Telephone | 440-666-3763
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------