1174573273 NPI number — COMMUNITY RADIOLOGY ASSOCIATES P A

Table of content: (NPI 1174573273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174573273 NPI number — COMMUNITY RADIOLOGY ASSOCIATES P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY RADIOLOGY ASSOCIATES P A
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:
1174573273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 208534
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-8534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-372-4197
Provider Business Mailing Address Fax Number:
210-614-7522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78738-5621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-820-8098
Provider Business Practice Location Address Fax Number:
210-614-7522
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEBLEU
Authorized Official First Name:
SHARLEE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
480-321-7026

Provider Taxonomy Codes

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

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

  • Identifier: 165256201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0078LC . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DB2103 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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