Provider Demographics
NPI:1891789939
Name:K&A RADIOLOGIC TECHNOLOGY SERVICES INC
Entity Type:Organization
Organization Name:K&A RADIOLOGIC TECHNOLOGY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-437-1622
Mailing Address - Street 1:6400 COLLAMER ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1032
Mailing Address - Country:US
Mailing Address - Phone:315-437-1622
Mailing Address - Fax:315-437-3190
Practice Address - Street 1:6400 COLLAMER ROAD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1032
Practice Address - Country:US
Practice Address - Phone:315-437-1622
Practice Address - Fax:315-437-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01676237Medicaid
NY01867596Medicaid
630000765Medicare PIN
NYBB6452Medicare PIN