Basic Information
| Provider Information | |||||||||
| NPI: | 1457754509 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL INSIGHTS DIAGNOSTIC CENTERS CONCORD PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26570 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937296570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009030912 | ||||||||
| FaxNumber: | 7706669102 | ||||||||
| Practice Location | |||||||||
| Address1: | 3195 FOLSOM BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167373211 | ||||||||
| FaxNumber: | 7706669103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 10/03/2014 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | VIRGIL | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5105078528 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A51264 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.