Provider Demographics
NPI:1295736015
Name:JACKSON RADIOLOGY CONSULTANTS, P C
Entity type:Organization
Organization Name:JACKSON RADIOLOGY CONSULTANTS, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIYUSH
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-783-2612
Mailing Address - Street 1:2800 SPRING ARBOR RD STE 102
Mailing Address - Street 2:PO BOX 905
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3895
Mailing Address - Country:US
Mailing Address - Phone:517-783-2612
Mailing Address - Fax:517-783-5991
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:IMAGING DEPARTMENT
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-783-2612
Practice Address - Fax:517-783-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty