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1003866773

NPI Code Detail

MEDICARE: RADIOLOGY ASSOCIATES OF TALLAHASSEE PA

MEDICARE: RADIOLOGY ASSOCIATES OF TALLAHASSEE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician
2	2085N0700X	Neuroradiology Physician
3	2085N0904X	Nuclear Radiology Physician
4	2085P0229X	Pediatric Radiology Physician
5	2085R0204X	Vascular & Interventional Radiology Physician
6	2085U0001X	Diagnostic Ultrasound Physician
7	2471C3401X	Computed Tomography Radiologic Technologist
8	2085R0202X	Diagnostic Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	00060	OTHER	FL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003866773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY ASSOCIATES OF TALLAHASSEE PA

Provider Business Mailing Address
First Line	:	PO BOX 1678
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32302-1678
Country	:	US
Telephone Number	:	850-878-4102
Fax Number	:	850-942-4155

Provider Business Practice Location Address
First Line	:	1600 PHILLIPS RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308-5304
Country	:	US
Telephone Number	:	850-878-4127
Fax Number	:	850-878-0337

Authorized Official
Title or Position	:	CEO
Name	:	JOHN R DETELICH
Credential	:
Telephone Number	:	850-878-4127

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	03/14/2014

Similar Medicare Providers

1639129521 — TALLAHASSEE DIAG IMAGING CTR LTD
Practice Location Address:

1600 PHILLIPS RD
TALLAHASSEE, FL
32308-5304

Practice Phone: 850-878-4127
Practice Fax: 850-878-9729

1548213879 — MICHAEL C CAVALLARO MD
Practice Location Address:

1600 PHILLIPS RD
TALLAHASSEE, FL
32308-5304

Practice Phone: 850-878-4127
Practice Fax: 850-878-0337

1629021811 — STEPHEN L CARR MD
Practice Location Address:

1600 PHILLIPS RD
TALLAHASSEE, FL
32308-5304

Practice Phone: 850-878-4127
Practice Fax: 850-878-0337

1316990328 — ARJUN V KAJI MD
Practice Location Address:

1600 PHILLIPS RD
TALLAHASSEE, FL
32308-5304

Practice Phone: 850-878-4127
Practice Fax: 850-878-0337

1982658555 — MARY E SWAIN MD
Practice Location Address:

1600 PHILLIPS RD
TALLAHASSEE, FL
32308-5304

Practice Phone: 850-878-4127
Practice Fax: 850-878-0337

1457305096 — WILLIAM M YAAKOB MD
Practice Location Address:

1600 PHILLIPS RD
TALLAHASSEE, FL
32308-5304

Practice Phone: 850-878-4127
Practice Fax: 850-878-0337

Directions to “RADIOLOGY ASSOCIATES OF TALLAHASSEE PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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