Basic Information
| Provider Information | |||||||||
| NPI: | 1063867190 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JRT RADIOLOGY SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 S. DURBIN SUITE 104 | ||||||||
| Address2: | |||||||||
| City: | CASPER | ||||||||
| State: | WY | ||||||||
| PostalCode: | 826012818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073374285 | ||||||||
| FaxNumber: | 3073330580 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825013230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078566530 | ||||||||
| FaxNumber: | 3073330580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2016 | ||||||||
| LastUpdateDate: | 09/12/2017 | ||||||||
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| AuthorizedOfficialLastName: | SKAF | ||||||||
| AuthorizedOfficialFirstName: | ZIAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3073374285 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | 5665A | WY | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.