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
StateLicense IDTaxonomies
PR207RC0000X
207U00000X, 2085B0100X, 2085D0003X, 2085N0700X, 2085N0904X, 2085R0202X, 2085U0001X, 2471C3401X, 2471C3402X, 2471M1202X, 2471M2300X, 2471N0900X, 2471V0105X, 261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Multi-Specialty
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine TechnologyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0080100OtherMEDICARE
PR80100Medicare PIN
PR80101Medicare PIN