1891762910 NPI number — RADIOLOGY ASSOCIATES OF THE TREASURE COAST PA INC

Table of content: (NPI 1891762910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891762910 NPI number — RADIOLOGY ASSOCIATES OF THE TREASURE COAST PA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES OF THE TREASURE COAST PA INC
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:
1891762910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JENSEN BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34958-0071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-263-3820
Provider Business Mailing Address Fax Number:
866-857-9967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
698 SW PORT ST LUCIE BLVD
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
PORT ST LUCIE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34953-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-873-4525
Provider Business Practice Location Address Fax Number:
772-873-4121
Provider Enumeration Date:
03/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEATON
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
772-873-4525

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: 38457 . This is a "BCBS PROVIDER GROUP ID#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CJ7124 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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