Provider Demographics
NPI:1669806402
Name:STOCKDALE RADIOLOGY PHYSICIANS SERVICES, INC
Entity type:Organization
Organization Name:STOCKDALE RADIOLOGY PHYSICIANS SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SUADI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:661-631-8000
Mailing Address - Street 1:4000 EMPIRE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0441
Mailing Address - Country:US
Mailing Address - Phone:661-631-8000
Mailing Address - Fax:661-631-8005
Practice Address - Street 1:4000 EMPIRE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0441
Practice Address - Country:US
Practice Address - Phone:661-631-8000
Practice Address - Fax:661-631-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A92632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF03091Medicare UPIN