1528224904 NPI number — RLC LLC

Table of content: (NPI 1528224904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528224904 NPI number — RLC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RLC LLC
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:
RADIOLOGY LTD. - CARONDELET
Provider Other Organization Name Type Code:
3
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:
1528224904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
677 N WILMOT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-2701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-795-2889
Provider Business Mailing Address Fax Number:
520-795-6321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6567 E CARONDELET DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85710-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-751-3096
Provider Business Practice Location Address Fax Number:
520-901-6630
Provider Enumeration Date:
08/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HARDESTY
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
520-545-1966

Provider Taxonomy Codes

  • Taxonomy code: 2085B0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X ; 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" .
  • Taxonomy code: 2085U0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: Z127535 . This is a "RLC LLC GROUP MEDICARE ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1528224904 . This is a "RLC LLC GROUP NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 422564 . This is a "RLC LLC GROUP MEDICAID ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P00749238 . This is a "RLC LLC GROUP MEDICARE RAILROAD ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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