Healthcare Provider Details

I. General information

NPI: 1639224058
Provider Name (Legal Business Name): RADIOLOGY ASSOCIATES OF OTTUMWA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 N MADISON ST
BLOOMFIELD IA
52537-1271
US

IV. Provider business mailing address

1005 PENNSYLVANIA AVE SUITE 103
OTTUMWA IA
52501-6413
US

V. Phone/Fax

Practice location:
  • Phone: 641-682-5453
  • Fax:
Mailing address:
  • Phone: 641-682-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCP7547
Identifier TypeOTHER
Identifier State
Identifier IssuerRAILROAD MEDICARE
# 2
Identifier7188177
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: ELVIN W MCCARL
Title or Position: PRESIDENT
Credential:
Phone: 641-682-5453