Provider Demographics
NPI:1417938903
Name:RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP
Entity Type:Organization
Organization Name:RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:GASCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-646-8300
Mailing Address - Street 1:1500 EXPO PKWY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4227
Mailing Address - Country:US
Mailing Address - Phone:916-646-8406
Mailing Address - Fax:916-920-4434
Practice Address - Street 1:3123 PROFESSIONAL DR
Practice Address - Street 2:STE 100
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2462
Practice Address - Country:US
Practice Address - Phone:530-888-8878
Practice Address - Fax:530-888-7635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207U00000X, 207UN0901X, 207UN0902X, 207UN0903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & TherapyGroup - Multi-Specialty
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR002851RMedicaid
CAGR002851RMedicaid