1114928207 NPI number — CASCADE RADIOLOGY CONSULTANTS, PC

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 1114928207 NPI number — CASCADE RADIOLOGY CONSULTANTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASCADE RADIOLOGY CONSULTANTS, PC
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:
1114928207
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1810 MULKEY RD
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
AUSTELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30106-1151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-980-8970
Provider Business Mailing Address Fax Number:
770-980-8975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 MULKEY RD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
AUSTELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30106-1151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-980-8970
Provider Business Practice Location Address Fax Number:
770-980-8975
Provider Enumeration Date:
08/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
FARAH
Authorized Official Middle Name:
BROWN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-980-8970

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)





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