Provider Demographics
NPI:1356640064
Name:CASPER TELERADIOLOGY, PLLC
Entity Type:Organization
Organization Name:CASPER TELERADIOLOGY, PLLC
Other - Org Name:CASPER RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-318-6682
Mailing Address - Street 1:410 PARK AVE
Mailing Address - Street 2:15TH FLOOR, SUITE #1240
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4407
Mailing Address - Country:US
Mailing Address - Phone:917-318-6682
Mailing Address - Fax:
Practice Address - Street 1:2735 SILVER CREEK RD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7924
Practice Address - Country:US
Practice Address - Phone:928-763-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty