Basic Information
| Provider Information | |||||||||
| NPI: | 1295736015 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JACKSON RADIOLOGY CONSULTANTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 SPRING ARBOR RD STE 102 | ||||||||
| Address2: | PO BOX 905 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492033895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177832612 | ||||||||
| FaxNumber: | 5177835991 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 N EAST AVE | ||||||||
| Address2: | IMAGING DEPARTMENT | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492011753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177832612 | ||||||||
| FaxNumber: | 5177835991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | PIYUSH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5177832612 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.