Provider Demographics
NPI:1790739985
Name:AMERIRAD INC
Entity Type:Organization
Organization Name:AMERIRAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-598-2291
Mailing Address - Street 1:PO BOX 1645
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1645
Mailing Address - Country:US
Mailing Address - Phone:304-598-2291
Mailing Address - Fax:304-598-2293
Practice Address - Street 1:99 J D ANDERSON DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-4000
Practice Address - Country:US
Practice Address - Phone:304-598-2291
Practice Address - Fax:304-598-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVNA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDE3255OtherRAILROAD MC
IL2650701Medicaid
WV3810001884Medicaid
OH601168805OtherUS DEPT. OF LABOR
OH601168805OtherFEDERAL BLACK LUNG
WV001706151OtherBCBS
PA101375266Medicaid
20460200OtherFEDERAL BLACK LUNG
OH000000365372OtherBCBSOH
601168800OtherUS DEPT. OF LABOR
WVDC1733OtherRAILROAD MC
COC810707Medicare PIN
IL215744Medicare PIN
20460200OtherFEDERAL BLACK LUNG
IL213807Medicare PIN
WVDC1733OtherRAILROAD MC
OH601168805OtherUS DEPT. OF LABOR