Provider Demographics
NPI: | 1558356493 |
---|---|
Name: | CT RADIOLOGY COMPLEX, LLC |
Entity Type: | Organization |
Organization Name: | CT RADIOLOGY COMPLEX, LLC |
Other - Org Name: | CT RADIOLOGY COMPLEX, LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | FINANCE VP |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | NORISELLE |
Authorized Official - Middle Name: | Z |
Authorized Official - Last Name: | RIVERA - POL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 787-621-3724 |
Mailing Address - Street 1: | PO BOX 602727 |
Mailing Address - Street 2: | |
Mailing Address - City: | BAYAMON |
Mailing Address - State: | PR |
Mailing Address - Zip Code: | 00960-6037 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 787-780-9069 |
Mailing Address - Fax: | 787-625-2626 |
Practice Address - Street 1: | 1815 RD 2 |
Practice Address - Street 2: | CT RADIOLOGY BUILDING |
Practice Address - City: | BAYAMON |
Practice Address - State: | PR |
Practice Address - Zip Code: | 00959-7279 |
Practice Address - Country: | US |
Practice Address - Phone: | 787-780-9069 |
Practice Address - Fax: | 787-780-2121 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-09-16 |
Last Update Date: | 2020-09-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PR | 207RC0000X | |
207U00000X, 2085B0100X, 2085D0003X, 2085N0700X, 2085N0904X, 2085R0202X, 2085U0001X, 2471C3401X, 2471C3402X, 2471M1202X, 2471M2300X, 2471N0900X, 2471V0105X, 261QM1200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
No | 2085D0003X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | Group - Multi-Specialty |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
No | 2085N0904X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 2471C3401X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Computed Tomography | Group - Multi-Specialty |
No | 2471C3402X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography | Group - Multi-Specialty |
No | 2471M1202X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Magnetic Resonance Imaging | Group - Multi-Specialty |
No | 2471M2300X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Mammography | Group - Multi-Specialty |
No | 2471N0900X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Nuclear Medicine Technology | Group - Multi-Specialty |
No | 2471V0105X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Vascular Sonography | Group - Multi-Specialty |
No | 261QM1200X | Ambulatory Health Care Facilities | Clinic/Center | Magnetic Resonance Imaging (MRI) | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PR | 0080100 | Other | MEDICARE |
PR | 80100 | Medicare PIN | |
PR | 80101 | Medicare PIN |