Provider Demographics
NPI:1659466126
Name:RADIOLOGIC MEDICAL SERVICES, PRO CORP
Entity Type:Organization
Organization Name:RADIOLOGIC MEDICAL SERVICES, PRO CORP
Other - Org Name:MUSCATINE RADIOLOGY, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-545-7310
Mailing Address - Street 1:2771 OAKDALE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9747
Mailing Address - Country:US
Mailing Address - Phone:319-545-7310
Mailing Address - Fax:319-626-7314
Practice Address - Street 1:2104 CEDARWOOD DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2662
Practice Address - Country:US
Practice Address - Phone:563-263-3400
Practice Address - Fax:563-263-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA02541OtherBLUE CROSS BLUE SHIELD
IA0025411Medicaid
IA0025411Medicaid