Provider Demographics
NPI:1487633780
Name:SHELBY RADIOLOGICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:SHELBY RADIOLOGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WEHMUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-482-3880
Mailing Address - Street 1:222 N LAFAYETTE ST
Mailing Address - Street 2:SUITE 01
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4444
Mailing Address - Country:US
Mailing Address - Phone:704-482-3880
Mailing Address - Fax:704-487-0294
Practice Address - Street 1:222 N LAFAYETTE ST
Practice Address - Street 2:SUITE 01
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4444
Practice Address - Country:US
Practice Address - Phone:704-482-3880
Practice Address - Fax:704-487-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC394192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
020837299OtherUS DEPARTMENT OF LABOR
148760XXOtherPREFERRED CARE
NC8902663Medicaid
SCE16337Medicaid
NC8902663Medicaid
204229Medicare ID - Type UnspecifiedRAIL ROAD MEDICARE