Provider Demographics
NPI: | 1710182688 |
---|---|
Name: | RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP, INC. |
Entity Type: | Organization |
Organization Name: | RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP, INC. |
Other - Org Name: | RADIOLOGICAL ASSOCIATES OF SACRAMENTO MEDICAL GROUP, INC. |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | EXECUTIVE VICE PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | FRED |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | GASCHEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 916-646-8300 |
Mailing Address - Street 1: | 1500 EXPO PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | SACRAMENTO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95815-4227 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 916-646-8300 |
Mailing Address - Fax: | 916-920-4434 |
Practice Address - Street 1: | 1500 EXPO PKWY |
Practice Address - Street 2: | |
Practice Address - City: | SACRAMENTO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95815-4227 |
Practice Address - Country: | US |
Practice Address - Phone: | 916-646-8300 |
Practice Address - Fax: | 916-920-4434 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-06-19 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
Not Answered | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
Not Answered | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
Not Answered | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | Group - Multi-Specialty |
Not Answered | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
Not Answered | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
Not Answered | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
Not Answered | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | GR002851X | Medicaid | |
CA | GR0092580 | Medicaid | |
CA | GR0092581 | Medicaid | |
CA | GR0092582 | Medicaid | |
CA | GR00285IR | Medicaid | |
CA | ZZZ00263Z | Medicaid | |
CA | GR0028514 | Medicaid | |
CA | GR0028517 | Medicaid | |
CA | GR0028516 | Medicaid | |
CA | GR0028519 | Medicaid | |
CA | ZZZ24943Z | Medicare ID - Type Unspecified | |
CA | ZZZ86038Z | Medicare ID - Type Unspecified | |
CA | GR0092580 | Medicaid | |
CA | GR0028514 | Medicaid | |
CA | ZZZ27152Z | Medicare ID - Type Unspecified | |
CA | ZZZ14323Z | Medicare ID - Type Unspecified | |
CA | GR0092582 | Medicaid | |
CA | GR0028515 | Medicare ID - Type Unspecified | |
CA | GR00285IR | Medicaid | |
CA | GR0028516 | Medicaid |