Basic Information
| Provider Information | |||||||||
| NPI: | 1215374194 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMBOLDT RADIOLOGY MEDICAL GROUP,INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6428 | ||||||||
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| City: | EUREKA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955026428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074427814 | ||||||||
| FaxNumber: | 7074453710 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 CIRCLE VIEW DR | ||||||||
| Address2: | |||||||||
| City: | NEW HOPE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189385619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074427814 | ||||||||
| FaxNumber: | 7074453710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2013 | ||||||||
| LastUpdateDate: | 05/31/2013 | ||||||||
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| AuthorizedOfficialLastName: | HOLLAND | ||||||||
| AuthorizedOfficialFirstName: | DEAN | ||||||||
| AuthorizedOfficialMiddleName: | GREGORY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/RADIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7074427814 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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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 |
No ID Information.