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General NPI Number Information
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NPI Number | 1841208071
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Entity Type | Organization
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Legal Business Name | RADIOLOGY MUSKEGON PC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/20/2021
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Provider Practice Location Address
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Address Line | 1500 E SHERMAN BLVD
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City | MUSKEGON
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State | MI
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Zip | 49444-1849
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Country | US
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Telephone | 231-672-3955
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Fax | 231-672-3806
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Provider Business Mailing Address
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Address Line | 605 W WESTERN AVE
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City | MUSKEGON
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State | MI
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Zip | 49440-1080
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Country | US
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Telephone | 231-722-6005
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Fax | 231-726-2804
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. STEPHEN C VAUGHAN
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Credential | CPA
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Telephone | 231-722-6005
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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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