Provider Demographics
NPI:1720032204
Name:CENTURY RADIOLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CENTURY RADIOLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-602-6810
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-0190
Mailing Address - Country:US
Mailing Address - Phone:805-522-5940
Mailing Address - Fax:805-522-6401
Practice Address - Street 1:3700 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1419
Practice Address - Country:US
Practice Address - Phone:562-602-6810
Practice Address - Fax:562-630-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0013841Medicaid
CE7194OtherRAILROAD MEDICARE
CAGR0013840Medicaid
CAZZZ76869ZMedicaid
ZZZ76869ZOtherBLUE SHIELD
ZZZ13785ZOtherBLUE SHIELD
ZZZ15759ZOtherBLUE SHIELD
ZZZ13968ZOtherBLUE SHIELD
CAGR0013840Medicaid