Provider Demographics
NPI:1083781249
Name:CASSIDY MEDICAL GROUP - RADIOLOGY
Entity type:Organization
Organization Name:CASSIDY MEDICAL GROUP - RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-630-5487
Mailing Address - Street 1:145 THUNDER DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6010
Mailing Address - Country:US
Mailing Address - Phone:760-630-5485
Mailing Address - Fax:760-630-5455
Practice Address - Street 1:145 THUNDER DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6010
Practice Address - Country:US
Practice Address - Phone:760-630-5485
Practice Address - Fax:760-630-5455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CASSIDY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty