Healthcare Provider Details

I. General information

NPI: 1447406772
Provider Name (Legal Business Name): ACCESS RADIOLOGY TECHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 WILLOW RD
MENLO PARK CA
94025-2617
US

IV. Provider business mailing address

PO BOX 612855
SAN JOSE CA
95161-2855
US

V. Phone/Fax

Practice location:
  • Phone: 650-324-8500
  • Fax:
Mailing address:
  • Phone: 408-829-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number177016308
License Number StateCA

VIII. Authorized Official

Name: MATHEW SHADIOW
Title or Position: CEO
Credential: ARRT, CRT, CA FLUORO
Phone: 408-829-2235