Basic Information
| Provider Information | |||||||||
| NPI: | 1124068499 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGIC CONSULTANTS LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 ACEE DRIVE | ||||||||
| Address2: | |||||||||
| City: | NATRONA HEIGHTS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002235544 | ||||||||
| FaxNumber: | 7242943206 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243577125 | ||||||||
| FaxNumber: | 7243577482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2006 | ||||||||
| LastUpdateDate: | 11/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | NEWCOMER | ||||||||
| AuthorizedOfficialFirstName: | DON | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 7242264510 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0156752 | 01 | UMWA | OTHER | 023164 | 01 | GROUP BS | OTHER | 1500608 | 01 | GATEWAY | OTHER | 0007167980009 | 01 | MEDICAL ASSISTANCE | OTHER | CN0798 | 01 | RR MEDICARE | OTHER | 0007167980009 | 05 | PA | MEDICAID | 45059 | 01 | HEALTH AMERICA | OTHER | 263623 | 01 | BLACK LUNG | OTHER |