1154790772 NPI number — SILVER CREEK RADIOLOGY PROFESSIONAL CORPORATION

Table of content: (NPI 1154790772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154790772 NPI number — SILVER CREEK RADIOLOGY PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER CREEK RADIOLOGY PROFESSIONAL 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:
6
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:
1154790772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1631
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-0032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
669-888-0001
Provider Business Mailing Address Fax Number:
669-888-0551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2365 QUIMBY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95122-1337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-427-9887
Provider Business Practice Location Address Fax Number:
650-618-5198
Provider Enumeration Date:
09/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PIATT
Authorized Official First Name:
BRADFORD
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
510-451-0780

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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