Healthcare Provider Details

I. General information

NPI: 1013482751
Provider Name (Legal Business Name): CENTURY RADIOLOGY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3224 FRESHWATER CRK
CHICO CA
95973-2120
US

IV. Provider business mailing address

PO BOX 51478
LOS ANGELES CA
90051-5778
US

V. Phone/Fax

Practice location:
  • Phone: 559-455-4009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK J SCHEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 562-531-2550