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General NPI Number Information
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NPI Number | 1376596742
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Entity Type | Organization
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Legal Business Name | RCOA-ADVENTIST HEALTH, LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1000 GREENLEY RD
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City | SONORA
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State | CA
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Zip | 95370-5200
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Country | US
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Telephone | 866-293-3500
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Fax | 866-293-3535
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Provider Business Mailing Address
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Address Line | P. O. BOX 85001
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City | ORLANDO
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State | FL
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Zip | 32885-0001
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Country | US
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Telephone | 866-293-3500
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Fax | 866-293-3535
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Authorized Official
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Title or Position | VP OF ACCOUNTING AND FINANCE
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Name | MR. DERRICK R MOORE
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Credential |
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Telephone | 561-477-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 6838-17
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License Number State | CA
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