Provider Demographics
NPI:1669474276
Name:SOUTHSIDE RADIOLOGY ASSOCIATES, INC
Entity Type:Organization
Organization Name:SOUTHSIDE RADIOLOGY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-491-7014
Mailing Address - Street 1:4110 WARRENSVILLE CTR RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7051
Mailing Address - Country:US
Mailing Address - Phone:216-491-7014
Mailing Address - Fax:216-491-7575
Practice Address - Street 1:4110 WARRENSVILLE CTR RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-7051
Practice Address - Country:US
Practice Address - Phone:216-491-7014
Practice Address - Fax:216-491-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0130941Medicaid
OH0130941Medicaid