Provider Demographics
NPI:1285912063
Name:MID MICHIGAN IMAGING SERVICES LLC
Entity type:Organization
Organization Name:MID MICHIGAN IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-715-9915
Mailing Address - Street 1:2370 S LINDEN RD STE 300A
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5429
Mailing Address - Country:US
Mailing Address - Phone:810-715-9915
Mailing Address - Fax:
Practice Address - Street 1:8273 S SAGINAW ST STE D
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2465
Practice Address - Country:US
Practice Address - Phone:810-606-0656
Practice Address - Fax:810-606-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-28
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010676272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty