Provider Demographics
NPI:1063867190
Name:JRT RADIOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:JRT RADIOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SKAF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-337-4285
Mailing Address - Street 1:428 S. DURBIN SUITE 104
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2818
Mailing Address - Country:US
Mailing Address - Phone:307-337-4285
Mailing Address - Fax:307-333-0580
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-3230
Practice Address - Country:US
Practice Address - Phone:307-856-6530
Practice Address - Fax:307-333-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5665A261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology