Provider Demographics
NPI:1710908041
Name:YADKIN RIVER RADIOLOGY PA
Entity Type:Organization
Organization Name:YADKIN RIVER RADIOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-760-4450
Mailing Address - Street 1:1365 WESTGATE CENTER DR
Mailing Address - Street 2:SUITE K-1
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2980
Mailing Address - Country:US
Mailing Address - Phone:336-760-4450
Mailing Address - Fax:336-760-6197
Practice Address - Street 1:1365 WESTGATE CENTER DR
Practice Address - Street 2:SUITE K-1
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2980
Practice Address - Country:US
Practice Address - Phone:336-760-4450
Practice Address - Fax:336-760-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015R1Medicaid
NC2336895Medicare ID - Type Unspecified