1104919000 NPI number — CONSULTING RADIOLOGISTS CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104919000 NPI number — CONSULTING RADIOLOGISTS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTING RADIOLOGISTS CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104919000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2658 W LASKEY RD
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43613-3288
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-473-8100
Provider Business Mailing Address Fax Number:
419-473-8109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2658 W LASKEY RD
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43613-3288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-473-8100
Provider Business Practice Location Address Fax Number:
419-473-8109
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MUNGUIA
Authorized Official First Name:
VERONICA
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
MEDICAL BILLER
Authorized Official Telephone Number:
419-254-2115

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1939853 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM1619 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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