Provider Demographics
NPI:1023315074
Name:TOWER IMAGING MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:TOWER IMAGING MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-549-3030
Mailing Address - Street 1:PO BOX 2365
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2365
Mailing Address - Country:US
Mailing Address - Phone:323-549-3030
Mailing Address - Fax:323-549-3049
Practice Address - Street 1:5455 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4201
Practice Address - Country:US
Practice Address - Phone:323-549-3030
Practice Address - Fax:323-549-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207U00000X, 2085N0700X
CA2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Single Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEX456AMedicare PIN