Provider Demographics
NPI: | 1821005976 |
---|---|
Name: | ASHEVILLE RADIOLOGY ASSOCIATES |
Entity Type: | Organization |
Organization Name: | ASHEVILLE RADIOLOGY ASSOCIATES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF ADMINISTRATIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOHN |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | BRAZIL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 828-213-0799 |
Mailing Address - Street 1: | PO BOX 2679 |
Mailing Address - Street 2: | |
Mailing Address - City: | ASHEVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28802-2679 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-258-0554 |
Mailing Address - Fax: | 828-253-1895 |
Practice Address - Street 1: | 84 COXE AVE |
Practice Address - Street 2: | |
Practice Address - City: | ASHEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28801-4167 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-253-3322 |
Practice Address - Fax: | 828-253-1895 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-02 |
Last Update Date: | 2012-05-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | ASDF | 204E00000X |
207U00000X, 2085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085R0204X, 2085U0001X, 208600000X, 2086S0129X, 208G00000X, 208VP0000X, 208VP0014X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | Group - Multi-Specialty | |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
No | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | Group - Multi-Specialty |
No | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | Group - Multi-Specialty |
No | 2085N0904X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | Group - Multi-Specialty |
No | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | Group - Multi-Specialty |
No | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | Group - Multi-Specialty |
No | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 208VP0000X | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | Group - Multi-Specialty |
No | 208VP0014X | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 012Y2 | Other | BCBS NC |