Provider Demographics
NPI:1003869595
Name:AMSCAN RADIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:AMSCAN RADIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANUPKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-509-0121
Mailing Address - Street 1:576 SIGMAN RD NE
Mailing Address - Street 2:500
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1326
Mailing Address - Country:US
Mailing Address - Phone:678-509-0121
Mailing Address - Fax:678-509-0163
Practice Address - Street 1:576 SIGMAN RD NE
Practice Address - Street 2:500
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1326
Practice Address - Country:US
Practice Address - Phone:678-509-0121
Practice Address - Fax:678-509-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA47BBBMHMedicare ID - Type Unspecified