Provider Demographics
NPI:1023084936
Name:WATAUGA RADIOLOGICAL SERVICES PA
Entity type:Organization
Organization Name:WATAUGA RADIOLOGICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GELDMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-264-6850
Mailing Address - Street 1:5711 CHAMBERLAYNE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2415
Mailing Address - Country:US
Mailing Address - Phone:804-262-6900
Mailing Address - Fax:804-266-3530
Practice Address - Street 1:5711 CHAMBERLAYNE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2415
Practice Address - Country:US
Practice Address - Phone:804-262-6900
Practice Address - Fax:804-266-3530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7902902Medicaid
ND204248Medicare PIN