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General NPI Number Information
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NPI Number | 1700847621
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Entity Type | Organization
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Legal Business Name | PLACERVILLE RADIOLOGY MEDICAL GROUP INC
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1100 MARSHALL WAY
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City | PLACERVILLE
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State | CA
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Zip | 95667-6533
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Country | US
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Telephone | 530-626-2613
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Fax | 530-344-5434
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Provider Business Mailing Address
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Address Line | PO BOX 1650
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City | EVANSVILLE
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State | IN
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Zip | 47706-0051
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Country | US
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Telephone | 530-626-2613
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Fax | 530-344-5434
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANIETIE OKON
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Credential | MD
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Telephone | 530-626-2613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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