Provider Demographics
NPI:1023155017
Name:COAST RADIOLOGY MEDICAL ASSOCIATES A CALIFORNIA GENERAL PARTNERSHIP
Entity type:Organization
Organization Name:COAST RADIOLOGY MEDICAL ASSOCIATES A CALIFORNIA GENERAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHELY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-473-7676
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-1507
Mailing Address - Country:US
Mailing Address - Phone:805-434-4989
Mailing Address - Fax:805-434-0721
Practice Address - Street 1:345 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3896
Practice Address - Country:US
Practice Address - Phone:805-434-4989
Practice Address - Fax:805-434-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24146ZOtherBLUE SHIELD GRP ID
CAGR0044610Medicaid
CAGR0044610Medicaid