Provider Demographics
NPI:1477628915
Name:HANSEN RICHEY RADIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:HANSEN RICHEY RADIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:RICHEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-384-2121
Mailing Address - Street 1:1240 D STREET
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-384-2121
Mailing Address - Fax:209-384-2135
Practice Address - Street 1:1240 D STREET
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-384-2121
Practice Address - Fax:209-384-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACK6752OtherRAILROAD MEDICARE PTAN
CAGR0092980Medicaid
CACK6752OtherRAILROAD MEDICARE PTAN