Provider Demographics
NPI:1982661948
Name:CT IMAGING SERVICE
Entity Type:Organization
Organization Name:CT IMAGING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-683-4451
Mailing Address - Street 1:1001 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6427
Mailing Address - Country:US
Mailing Address - Phone:641-683-4451
Mailing Address - Fax:641-684-2931
Practice Address - Street 1:1001 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6427
Practice Address - Country:US
Practice Address - Phone:641-683-4451
Practice Address - Fax:641-684-2931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA002754OtherCHAMPUS
IA0200949Medicaid
IAIA100OtherJOHN DEERE HEALTH
IA20094OtherBLUE CROSS & BLUE SHIELD
IA0200949Medicaid