=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982777348
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-COUNTY MEDICAL IMAGING SERVICES,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 W PUTNAM AVE SUITE 2 B
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93257-3257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-782-1973
-----------------------------------------------------
Fax | 559-782-1976
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8613
-----------------------------------------------------
City | PORTERVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93258-8613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-782-1973
-----------------------------------------------------
Fax | 559-782-1976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. ELLA JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-782-1973
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number | 054353
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0208X
-----------------------------------------------------
Taxonomy Name | Mobile Radiology Clinic/Center
-----------------------------------------------------
License Number | 054353
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------