1558328963 NPI number — RADIOLOGY ASSOCIATES LLC

Table of content: (NPI 1558328963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558328963 NPI number — RADIOLOGY ASSOCIATES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIOLOGY ASSOCIATES 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:
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:
1558328963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17507
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33762-0507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-896-9068
Provider Business Mailing Address Fax Number:
772-621-3184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2115 LITTLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRINITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-847-5122
Provider Business Practice Location Address Fax Number:
727-843-8832
Provider Enumeration Date:
04/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAPLAN
Authorized Official First Name:
TODD
Authorized Official Middle Name:
Authorized Official Title or Position:
MD /OWNER
Authorized Official Telephone Number:
727-841-8225

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)

  • Identifier: 00603 . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 059510101 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ0133 . This is a "RR MCR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V002J . This is a "FLORIDA BLUE (BCBS) - HUDSON/SR52 LOCATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: V2329 . This is a "FLORIDA BLUE (BCBS) - MARINE PARKWAY LOCATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 059510100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 059510102 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: V002H . This is a "FLORIDA BLUE (BCBS) - TRINITY LOCATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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