MEDICARE: MOUNTAINEER RADIOLOGISTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	001711957	OTHER	WV	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154320869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINEER RADIOLOGISTS INC

Provider Business Mailing Address
First Line	:	PO BOX 1111
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25324-1111
Country	:	US
Telephone Number	:	304-951-1588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1306 KANAWHA BLVD E
Second Line	:	BUILDING 2
City	:	CHARLESTON
State	:	WV
Zip	:	25301-3000
Country	:	US
Telephone Number	:	304-951-1588
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS ZEKAN
Credential	:	MD
Telephone Number	:	304-951-1588

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/16/2015

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Directions to “MOUNTAINEER RADIOLOGISTS INC ” Practice Location

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