Provider Demographics
NPI:1023074390
Name:RADIOLOGY ASSOCIATES OF KEENE PC
Entity type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF KEENE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUTRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-427-6700
Mailing Address - Street 1:217 OLD HOMESTEAD HWY
Mailing Address - Street 2:
Mailing Address - City:SWANZEY
Mailing Address - State:NH
Mailing Address - Zip Code:03446-2140
Mailing Address - Country:US
Mailing Address - Phone:603-352-5881
Mailing Address - Fax:603-357-0059
Practice Address - Street 1:580 COURT ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1715
Practice Address - Country:US
Practice Address - Phone:603-354-6580
Practice Address - Fax:603-357-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81300105Medicaid
NH81300105Medicaid