Provider Demographics
NPI:1619925260
Name:DUBUQUE RADIOLOGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:DUBUQUE RADIOLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-556-6895
Mailing Address - Street 1:998 FREMONT AVE STE L5
Mailing Address - Street 2:PO BOX 1655
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003-0300
Mailing Address - Country:US
Mailing Address - Phone:563-556-6895
Mailing Address - Fax:563-556-3618
Practice Address - Street 1:350 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6392
Practice Address - Country:US
Practice Address - Phone:563-582-1881
Practice Address - Fax:563-589-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA30951OtherWELLMARK FINLEY
WI32651500Medicaid
IL4323751OtherBLUE SHIELD
IA04719OtherWELLMARK OFFICE LOCATION
IA32663OtherWELLMARK MAQUOKETA LOCATI
IA0145417Medicaid
IA0147348Medicaid
WI=========011OtherBCBS UNITED OF WI
IA0145417Medicaid
WI000024115Medicare ID - Type UnspecifiedWPS
IA0147348Medicaid