Provider Demographics
NPI:1366482093
Name:SAINT VINCENT RADIOLOGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SAINT VINCENT RADIOLOGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-939-2035
Mailing Address - Street 1:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-0824
Mailing Address - Country:US
Mailing Address - Phone:978-939-2035
Mailing Address - Fax:978-939-2039
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-5000
Practice Address - Fax:978-939-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207R00000X, 207U00000X, 2085N0700X, 2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9703284OtherHEALTHY START
MA49925OtherFALLON ATHOL
MA600428OtherHARVARD PILGRIM HEALTH PL
MA6070OtherFALLON COMMUNITY HEALTH P
MA800185OtherTUFTS HEALTH PLAN
MA9703284Medicaid
MA62965OtherAETNA
MACK1296OtherRAILROAD MEDICARE
MA49925OtherFALLON ATHOL
MA600428OtherHARVARD PILGRIM HEALTH PL
MA800185OtherTUFTS HEALTH PLAN
MA=========OtherPRIVATE HEALTH CARE SYSTE
MA9703284OtherHEALTHY START
MA9703284OtherHEALTHY START