Provider Demographics
NPI:1912942616
Name:HIGH COUNTRY IMAGING,INC
Entity type:Organization
Organization Name:HIGH COUNTRY IMAGING,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAJDAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-727-0266
Mailing Address - Street 1:1987B S SHADY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37683-2021
Mailing Address - Country:US
Mailing Address - Phone:423-727-0266
Mailing Address - Fax:423-727-0366
Practice Address - Street 1:1987B S SHADY ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CITY
Practice Address - State:TN
Practice Address - Zip Code:37683-2021
Practice Address - Country:US
Practice Address - Phone:423-727-0266
Practice Address - Fax:423-727-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4113524OtherBLUE CROSS BLUE SHIELD NE
TN3791398Medicaid
TN3791398Medicare ID - Type Unspecified