Basic Information
Provider Information | |||||||||
NPI: | 1518299957 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | F&S RADIOLOGY PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5565 CENTERVIEW DR STE 107 | ||||||||
Address2: |   | ||||||||
City: | RALEIGH | ||||||||
State: | NC | ||||||||
PostalCode: | 276063563 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: |   | ||||||||
FaxNumber: | 8663968340 | ||||||||
Practice Location | |||||||||
Address1: | 3700 PARK EAST DR | ||||||||
Address2: | SUITE 450 | ||||||||
City: | BEACHWOOD | ||||||||
State: | OH | ||||||||
PostalCode: | 441224305 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8552921401 | ||||||||
FaxNumber: | 8663968340 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/10/2010 | ||||||||
LastUpdateDate: | 07/08/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KONDAS | ||||||||
AuthorizedOfficialFirstName: | KATHY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
AuthorizedOfficialTelephone: | 8773281119 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/08/2021 |
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 | 442184100 | 05 | MD |   | MEDICAID | 1518299957 | 05 | CA |   | MEDICAID | GP5506 | 05 | SC |   | MEDICAID | 0020746 | 05 | FL |   | MEDICAID | 3076853 | 05 | OH |   | MEDICAID | 003116726A | 05 | GA |   | MEDICAID | 057763900 | 05 | DC |   | MEDICAID | 681560 | 05 | AZ |   | MEDICAID | 7100111880 | 05 | KY |   | MEDICAID | 1025173750001 | 05 | PA |   | MEDICAID |