Provider Demographics
NPI:1710963418
Name:RAD-IMAGE MEDICAL GROUP INC
Entity Type:Organization
Organization Name:RAD-IMAGE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:M
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-590-7400
Mailing Address - Street 1:100 OCEANGATE
Mailing Address - Street 2:STE 1000
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4312
Mailing Address - Country:US
Mailing Address - Phone:562-590-7400
Mailing Address - Fax:562-590-7452
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:LONG BEACH MEMORIAL MEDICAL CENTER
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1737
Practice Address - Country:US
Practice Address - Phone:562-933-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Not Answered2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
Not Answered2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64951ZOtherBLUE SHIELD
CAZZZ64952ZOtherBLUE SHIELD
CAZZZ94679ZOtherBLUE SHIELD
CAGR0010881OtherMEDICAL
CAGR0020883OtherMEDICAL
CAGR0010882OtherMEDICAL
W16865Medicare ID - Type Unspecified