1912725771 NPI number — RADIOLOGY ASSOCIATES OF TALLAHASSEE PA

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 1912725771 NPI number — RADIOLOGY ASSOCIATES OF TALLAHASSEE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES OF TALLAHASSEE PA
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:
1912725771
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20747
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33622-0747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-475-6112
Provider Business Mailing Address Fax Number:
706-653-1230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 N ARNOLD RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
PANAMA CITY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32413-2291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-238-4100
Provider Business Practice Location Address Fax Number:
706-653-1230
Provider Enumeration Date:
10/01/2024

Additional Information

Authorized Official

Authorized Official Last Name:
DETELICH
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
850-878-4127

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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