Provider Demographics
NPI:1013096056
Name:KLAMATH RADIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:KLAMATH RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAMPLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-884-1371
Mailing Address - Street 1:2900 DAGGETT AVE
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-7101
Mailing Address - Country:US
Mailing Address - Phone:541-884-1371
Mailing Address - Fax:541-882-3862
Practice Address - Street 1:2900 DAGGETT AVE
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-7101
Practice Address - Country:US
Practice Address - Phone:541-884-1371
Practice Address - Fax:541-882-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR0000WCGFKMedicare ID - Type Unspecified