PLACERVILLE RADIOLOGY MEDICAL GROUP INC NPI 1700847621

NPI Information

NPI: 1700847621
Provider Name: PLACERVILLE RADIOLOGY MEDICAL GROUP INC
Classification: Radiology - 2085R0202X
Entity Type: Organization

Specialization: Diagnostic Radiology

Address:
1100 MARSHALL WAY
PLACERVILLE, CA
ZIP 95667
Phone: (530) 622-1441
Get Directions

PLACERVILLE RADIOLOGY MEDICAL GROUP INC is a diagnostic radiology radiology in Placerville, CA. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. PLACERVILLE RADIOLOGY MEDICAL GROUP INC NPI is 1700847621. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

1100 MARSHALL WAY
PLACERVILLE, CA
ZIP 95667-533
Phone: (530) 622-1441

The provider's authorized official is Anietie Okon .
The authorized official title is President and has the following contact phone number (530) 626-2613.

The enumeration date for this NPI number is 3/30/2006 and was last updated on 10/9/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	2085B0100X	Radiology	Body Imaging	CALIFORNIA	No
2	2085N0700X	Radiology	Neuroradiology	CALIFORNIA	No
3	2085N0904X	Radiology	Nuclear Radiology	CALIFORNIA	No
4	2085R0203X	Radiology	Therapeutic Radiology	CALIFORNIA	No
5	2085R0204X	Radiology	Vascular & Interventional Radiology	CALIFORNIA	No
6	2085R0205X	Radiology	Radiological Physics	CALIFORNIA	No
7	2085U0001X	Radiology	Diagnostic Ultrasound	CALIFORNIA	No
8	2085R0202X	Radiology	Diagnostic Radiology	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GR0053460	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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