Provider Demographics
NPI:1891352068
Name:DIRECT RADIOLOGY CALIFORNIA PC
Entity Type:Organization
Organization Name:DIRECT RADIOLOGY CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-687-7237
Mailing Address - Street 1:1839 N GOVERNMENT WAY STE B
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3454
Mailing Address - Country:US
Mailing Address - Phone:855-687-7237
Mailing Address - Fax:
Practice Address - Street 1:1839 N GOVERNMENT WAY STE B
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3454
Practice Address - Country:US
Practice Address - Phone:855-687-7237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty