Provider Demographics
NPI:1427057967
Name:REGIONAL MEDICAL IMAGING, P.C.
Entity type:Organization
Organization Name:REGIONAL MEDICAL IMAGING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-732-1919
Mailing Address - Street 1:3346 LENNON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-1015
Mailing Address - Country:US
Mailing Address - Phone:810-244-7109
Mailing Address - Fax:810-732-3740
Practice Address - Street 1:3346 LENNON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1015
Practice Address - Country:US
Practice Address - Phone:810-732-1919
Practice Address - Fax:810-732-1945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010486822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI310B562940OtherBS & BCN PROVIDER NUMBER
MI=========OtherTAX ID NUMBER
MI=========OtherTAX ID NUMBER