Provider Demographics
NPI:1477872919
Name:BEVERLY RADIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:BEVERLY RADIOLOGY MEDICAL GROUP
Other - Org Name:SAN BERNARDINO ADVANCED IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-445-4800
Mailing Address - Street 1:800 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4006
Mailing Address - Country:US
Mailing Address - Phone:909-799-5589
Mailing Address - Fax:909-881-8625
Practice Address - Street 1:800 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4006
Practice Address - Country:US
Practice Address - Phone:909-799-5589
Practice Address - Fax:909-881-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-24
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty