Provider Demographics
NPI:1659449650
Name:RADCO MANAGEMENT, LLC
Entity Type:Organization
Organization Name:RADCO MANAGEMENT, LLC
Other - Org Name:PREMIER IMAGING OF WHITTIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:REYNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:NISHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-267-0170
Mailing Address - Street 1:15725 WHITTIER BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2347
Mailing Address - Country:US
Mailing Address - Phone:562-267-0170
Mailing Address - Fax:562-267-0173
Practice Address - Street 1:15725 WHITTIER BLVD
Practice Address - Street 2:STE B
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2347
Practice Address - Country:US
Practice Address - Phone:562-267-0170
Practice Address - Fax:562-267-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD071Medicare ID - Type Unspecified