NPIMap

Organization Active NPI

Radiology Associates of Tallahassee, PA

  • Diagnostic Radiology Physician
  • Marianna, FL
National Provider Identifier
1417525494
Registry record updated Jun 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
RADIOLOGY ASSOCIATES OF TALLAHASSEE, PA
Practice address
4250 Hospital Dr
Marianna, FL 32446-1917
Phone
(800) 475-6112
NPI assigned
Jun 15, 2021
Last updated
Jun 15, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
RADIOLOGY ASSOCIATES OF TALLAHASSEE, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John R Detelich
Title
Ceo
Phone
(850) 878-4127

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X NU Primary

Addresses

Primary practice location

4250 Hospital Dr
Marianna, FL 32446-1917

Mailing address

PO Box 20747
Tampa, FL 33622-0747
Phone (800) 475-6112

National Provider Directory

National Provider Directory
Tax ID family
Eric H Loevinger6 organizations share this tax ID, including this one
Part of
Eric H Loevinger

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623715200000",
    "number": "1417525494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20747",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336220747",
            "telephone_number": "800-475-6112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 HOSPITAL DR",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324461917",
            "telephone_number": "800-475-6112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIOLOGY ASSOCIATES OF TALLAHASSEE, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RADIOLOGY ASSOCIATES OF TALLAHASSEE, PA",
        "enumeration_date": "2021-06-15",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-15",
        "status": "A",
        "authorized_official_last_name": "DETELICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-878-4127"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marianna, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.