Provider Demographics
NPI:1417525494
Name:RADIOLOGY ASSOCIATES OF TALLAHASSEE, PA
Entity Type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF TALLAHASSEE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DETELICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-878-4127
Mailing Address - Street 1:PO BOX 20747
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-0747
Mailing Address - Country:US
Mailing Address - Phone:800-475-6112
Mailing Address - Fax:
Practice Address - Street 1:4250 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-1917
Practice Address - Country:US
Practice Address - Phone:800-475-6112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY ASSOCIATES OF TALLAHASSEE, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty