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NPI Code Detail

MEDICARE: EASTERN SIERRA RADIOLOGY

MEDICARE: EASTERN SIERRA RADIOLOGY
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
12085R0202XDiagnostic Radiology PhysicianA22120CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2ZZZ04744ZOTHERCABLUE SHIELD
3A22120OTHERCABLUE CROSS

General Provider Information

NPI Number : 1790798460
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERN SIERRA RADIOLOGY
Provider Business Mailing Address
First Line : 333 N SANTA ANITA AVE
Second Line : SUITE 9
City : ARCADIA
State : CA
Zip : 91006-2863
Country : US
Telephone Number : 626-445-0004
Fax Number : 626-445-0302
Provider Business Practice Location Address
First Line : 150 PIONEER LN
Second Line :
City : BISHOP
State : CA
Zip : 93514-2556
Country : US
Telephone Number : 760-873-2171
Fax Number : 626-445-0302
Authorized Official
Title or Position : PRESIDENT
Name : JOHN WILLARD NESSON
Credential : M.D.
Telephone Number : 626-445-0004
Provider Enumeration Date : 08/14/2006
Last Update Date : 08/22/2020

Similar Medicare Providers

1285628081 — DR. THEODORE W RASOUMOFF M.D.
Practice Location Address:
150 PIONEER LN
BISHOP, CA
93514-2556
Practice Phone: 760-873-5811
Practice Fax:
1609851252 — DORIS LIN M.D.
Practice Location Address:
150 PIONEER LN
BISHOP, CA
93514-2556
Practice Phone: 760-873-5811
Practice Fax:
1063488757 — JAMES M. EIDEL MD
Practice Location Address:
150 PIONEER LN
BISHOP, CA
93514-2556
Practice Phone: 760-873-5811
Practice Fax: 760-872-5843
1629004650 — DR. STACEY LEE BROWN MD
Practice Location Address:
150 PIONEER LN
BISHOP, CA
93514-2556
Practice Phone: 760-920-0520
Practice Fax: 760-873-2897
1891714325 — DR. JOHN DANIEL COWAN MD
Practice Location Address:
150 PIONEER LN
BISHOP, CA
93514-2556
Practice Phone: 760-873-5811
Practice Fax: 760-873-5811
1487667101 — JOHN WILLARD NESSON M.D.
Practice Location Address:
150 PIONEER LN
BISHOP, CA
93514-2556
Practice Phone: 760-873-2171
Practice Fax: 626-445-0302

Directions to “EASTERN SIERRA RADIOLOGY ” Practice Location

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