MEDICARE: CENTURY RADIOLOGY MEDICAL GROUP, INC

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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1568095123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTURY RADIOLOGY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	PO BOX 102337
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91189-2337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7102 BETHENCOURT
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3407
Country	:	US
Telephone Number	:	800-236-4469
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK J SCHEIN
Credential	:	MD
Telephone Number	:	562-531-2550

Provider Enumeration Date	:	02/21/2020
Last Update Date	:	02/21/2020

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