Healthcare Provider Details

I. General information

NPI: 1871538504
Provider Name (Legal Business Name): DIAGNOSTIC RADIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MICKELSON DR STE 2
WATERTOWN SD
57201-7253
US

IV. Provider business mailing address

1201 MICKELSON DR STE 2
WATERTOWN SD
57201-7253
US

V. Phone/Fax

Practice location:
  • Phone: 605-882-0432
  • Fax: 605-882-0978
Mailing address:
  • Phone: 605-882-0432
  • Fax: 605-882-0978

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: WILLIAM K BISHOP
Title or Position: PROVIDER
Credential: MD
Phone: 605-882-0432