Provider Demographics
NPI:1477161214
Name:RADIUS MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:RADIUS MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-931-9787
Mailing Address - Street 1:2425 E COMMERCIAL BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4062
Mailing Address - Country:US
Mailing Address - Phone:954-931-9787
Mailing Address - Fax:954-915-9041
Practice Address - Street 1:2425 E COMMERCIAL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4062
Practice Address - Country:US
Practice Address - Phone:954-931-9787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty