Basic Information
| Provider Information | |||||||||
| NPI: | 1134153240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY CONSULTING ASSOCIATES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1888 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009452455 | ||||||||
| FaxNumber: | 9034532541 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 HIGHWAY 243 WEST | ||||||||
| Address2: | |||||||||
| City: | KAUFMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729327200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 05/13/2008 | ||||||||
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| AuthorizedOfficialLastName: | COLLIER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9725516931 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 112569201 | 05 | TX | MEDICAID |