Provider Demographics
NPI:1518909803
Name:MONTGOMERY RADIOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:MONTGOMERY RADIOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MANGELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-951-4992
Mailing Address - Street 1:2001 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6678
Mailing Address - Country:US
Mailing Address - Phone:540-951-4992
Mailing Address - Fax:540-951-0302
Practice Address - Street 1:2001 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6678
Practice Address - Country:US
Practice Address - Phone:540-951-4992
Practice Address - Fax:540-951-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00735Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER