Provider Demographics
NPI:1477767986
Name:SOUTHTOWNS RADIOLOGY ASSOCIATES,LLC
Entity Type:Organization
Organization Name:SOUTHTOWNS RADIOLOGY ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-649-9000
Mailing Address - Street 1:3040 AMSDELL RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5835
Mailing Address - Country:US
Mailing Address - Phone:716-649-9000
Mailing Address - Fax:716-649-9005
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-558-5140
Practice Address - Fax:716-674-2697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14422AMedicare ID - Type Unspecified