Provider Demographics
NPI:1174521330
Name:CLINTON X-RAY ASSOCIATES, PA
Entity type:Organization
Organization Name:CLINTON X-RAY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:MCDEVITT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-592-8070
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28329-0619
Mailing Address - Country:US
Mailing Address - Phone:910-592-8070
Mailing Address - Fax:
Practice Address - Street 1:409 COOPER DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2817
Practice Address - Country:US
Practice Address - Phone:910-592-8070
Practice Address - Fax:910-592-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890122GMedicaid
NC0122GOtherBCBS OF NC
204338Medicare ID - Type Unspecified