Basic Information
| Provider Information | |||||||||
| NPI: | 1558328963 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY ASSOCIATES LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RADIOLOGY ASSOCIATES OF WEST PASCO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17507 | ||||||||
| Address2: | |||||||||
| City: | CLEARWATER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337620507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448969068 | ||||||||
| FaxNumber: | 7726213184 | ||||||||
| Practice Location | |||||||||
| Address1: | 2115 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | TRINITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278475122 | ||||||||
| FaxNumber: | 7278438832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
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| AuthorizedOfficialLastName: | KAPLAN | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD /OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7278418225 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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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 | 00603 | 01 | FL | MEDICARE | OTHER | 059510101 | 05 | FL | MEDICAID | CJ0133 | 01 | FL | RR MCR | OTHER | V002J | 01 | FL | FLORIDA BLUE (BCBS) - HUDSON/SR52 LOCATION | OTHER | V2329 | 01 | FL | FLORIDA BLUE (BCBS) - MARINE PARKWAY LOCATION | OTHER | 059510100 | 05 | FL | MEDICAID | 059510102 | 05 | FL | MEDICAID | V002H | 01 | FL | FLORIDA BLUE (BCBS) - TRINITY LOCATION | OTHER |