Provider Demographics
NPI:1588954929
Name:MODESTO RADIOLOGY IMAGING, INC.
Entity type:Organization
Organization Name:MODESTO RADIOLOGY IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAIKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISHNASWAMY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-713-3500
Mailing Address - Street 1:1524 MCHENRY AVE
Mailing Address - Street 2:# 100
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4500
Mailing Address - Country:US
Mailing Address - Phone:209-577-4444
Mailing Address - Fax:209-527-2069
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:# 100
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-577-4444
Practice Address - Fax:209-527-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty