Provider Demographics
NPI:1033151931
Name:NORTH STATE RADIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NORTH STATE RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:LETNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-898-0504
Mailing Address - Street 1:1720 ESPLANADE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3315
Mailing Address - Country:US
Mailing Address - Phone:530-898-0504
Mailing Address - Fax:530-898-9647
Practice Address - Street 1:1720 ESPLANADE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-898-0504
Practice Address - Fax:530-898-9647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ 00858 ZMedicare ID - Type Unspecified