Provider Demographics
NPI:1154320869
Name:MOUNTAINEER RADIOLOGISTS INC
Entity Type:Organization
Organization Name:MOUNTAINEER RADIOLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEKAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-951-1588
Mailing Address - Street 1:PO BOX 1111
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25324-1111
Mailing Address - Country:US
Mailing Address - Phone:304-951-1588
Mailing Address - Fax:
Practice Address - Street 1:1306 KANAWHA BLVD E
Practice Address - Street 2:BUILDING 2
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-3000
Practice Address - Country:US
Practice Address - Phone:304-951-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006507Medicaid
VA1154320869Medicaid
WV001711957OtherBCBS
WV3810006508Medicaid
WV3810002431Medicaid
WV3810002431Medicaid
WVID01681Medicare ID - Type Unspecified
WV3810002431Medicaid