Provider Demographics
NPI:1174552202
Name:CLEVELAND RADIOLOGY ASSOCIATES, PC
Entity type:Organization
Organization Name:CLEVELAND RADIOLOGY ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-479-6214
Mailing Address - Street 1:PO BOX 3990
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-3990
Mailing Address - Country:US
Mailing Address - Phone:423-479-6214
Mailing Address - Fax:423-614-4405
Practice Address - Street 1:2370 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3850
Practice Address - Country:US
Practice Address - Phone:423-479-6214
Practice Address - Fax:423-614-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373976Medicare ID - Type UnspecifiedGROUP NUMBER