MEDICARE: RADIOLOGY ASSOCIATES OF CLEARWATER

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		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	CC5325	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00212	OTHER	FL	BCBS GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	0007619	OTHER	FL	AETNA GROUP NUMBER

General Provider Information

NPI Number	:	1982694899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY ASSOCIATES OF CLEARWATER

Provider Business Mailing Address
First Line	:	PO BOX 223834
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15251-2834
Country	:	US
Telephone Number	:	727-793-9300
Fax Number	:	727-793-0052

Provider Business Practice Location Address
First Line	:	300 PINELLAS ST
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33756-3804
Country	:	US
Telephone Number	:	727-441-3711
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN S FISHER
Credential	:	M. D.
Telephone Number	:	727-441-3711

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/21/2022

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