Provider Demographics
NPI:1083663686
Name:RADIOLOGY IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:RADIOLOGY IMAGING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:RAFFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-398-2233
Mailing Address - Street 1:27034 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1270
Mailing Address - Country:US
Mailing Address - Phone:585-241-6851
Mailing Address - Fax:585-387-9193
Practice Address - Street 1:1825 SE TIFFANY AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7554
Practice Address - Country:US
Practice Address - Phone:772-398-2233
Practice Address - Fax:772-380-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039279100Medicaid
FL060602200Medicaid
FL069326000Medicaid
FL051223100Medicaid
FL069259000Medicaid
FL069271900Medicaid
FL56120Medicare ID - Type UnspecifiedEDWARD GALLAGHER, MD
FL56109Medicare ID - Type UnspecifiedROBERT F. BASILICO, MD
FLE12158Medicare UPIN
FL060602200Medicaid
FL069259000Medicaid
FLD86376Medicare UPIN
FL00052Medicare ID - Type UnspecifiedGROUP ID MEDICARE NUMBER
FL069326000Medicaid
FLD56766Medicare UPIN
FL051223100Medicaid
FL069271900Medicaid