Provider Demographics
NPI:1841261989
Name:RADIOLOGY LTD., LLC
Entity type:Organization
Organization Name:RADIOLOGY LTD., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-689-1691
Mailing Address - Street 1:677 N WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2701
Mailing Address - Country:US
Mailing Address - Phone:520-795-2889
Mailing Address - Fax:520-795-6321
Practice Address - Street 1:677 N WILMOT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2701
Practice Address - Country:US
Practice Address - Phone:520-795-2889
Practice Address - Fax:520-795-6321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCS7943OtherGROUP MEDICARE RAILROAD ID # & PTAN
AZ1841261989OtherGROUP NPI
AZ001481Medicaid
AZCS7943OtherGROUP MEDICARE RAILROAD ID # & PTAN
AZ1841261989OtherGROUP NPI
AZWCBBMOtherGROUP MEDICARE ID (ORIGINAL ID #)
AZZWCBBMOtherGROUP MEDICARE ID (CURRENT ID #)
AZZWCBBMMedicare PIN