MEDICARE: BIODATA RADIOLOGY SERVICES 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	:	1871243840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIODATA RADIOLOGY SERVICES INC

Provider Business Mailing Address
First Line	:	1218 E ARABIAN LN
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-6735
Country	:	US
Telephone Number	:	800-558-0312
Fax Number	:	949-281-7707

Provider Business Practice Location Address
First Line	:	1218 E ARABIAN LN
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208-6735
Country	:	US
Telephone Number	:	800-558-0312
Fax Number	:	949-281-7707

Authorized Official
Title or Position	:	PARTNER
Name	:	MARTIN CANALES
Credential	:
Telephone Number	:	949-258-9883

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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