Provider Demographics
NPI:1487801924
Name:VALLEY IMAGING PARTNERS, P.C.
Entity type:Organization
Organization Name:VALLEY IMAGING PARTNERS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDRICK
Authorized Official - Middle Name:JORDAN
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-591-2632
Mailing Address - Street 1:P.O. BOX 97
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347
Mailing Address - Country:US
Mailing Address - Phone:423-591-2632
Mailing Address - Fax:423-837-9549
Practice Address - Street 1:1000 HWY 28
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347
Practice Address - Country:US
Practice Address - Phone:423-591-2632
Practice Address - Fax:423-837-9549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000263072085R0202X
TNMD263072085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1507509Medicaid
TN4191955OtherBLUE CROSS BLUE SHIELD
TN1507509Medicaid