MEDICARE: SOUTHSIDE RADIOLOGY ASSOCIATES, 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

General Provider Information

NPI Number	:	1669474276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHSIDE RADIOLOGY ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	4110 WARRENSVILLE CTR RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44122-7051
Country	:	US
Telephone Number	:	216-491-7014
Fax Number	:	216-491-7575

Provider Business Practice Location Address
First Line	:	4110 WARRENSVILLE CTR RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44122-7051
Country	:	US
Telephone Number	:	216-491-7014
Fax Number	:	216-491-7575

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY UNGER
Credential	:
Telephone Number	:	216-491-7014

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	01/24/2008

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Directions to “SOUTHSIDE RADIOLOGY ASSOCIATES, INC ” Practice Location

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