Provider Demographics
NPI:1578639209
Name:LOUIS J RADNOTHY DO PA
Entity Type:Organization
Organization Name:LOUIS J RADNOTHY DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DHARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-669-3175
Mailing Address - Street 1:PO BOX 2325
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-2325
Mailing Address - Country:US
Mailing Address - Phone:352-669-3175
Mailing Address - Fax:352-669-3640
Practice Address - Street 1:390 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-2325
Practice Address - Country:US
Practice Address - Phone:352-669-3175
Practice Address - Fax:352-669-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL660044100Medicaid
FL82509OtherBS
FLD27370Medicare UPIN
FL103901Medicare Oscar/Certification
FL82509OtherBS