Southeast Radiology Consultants LLC

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

5533 Issued in AK

Legal business name

SOUTHEAST RADIOLOGY CONSULTANTS LLC

Practice address

3260 Hospital Dr
Juneau, AK 99801-7808

Phone

(907) 796-8631

NPI assigned

Jun 5, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Theresa J Shanley, M.D.

Title

Managing Member

Phone

(907) 321-1953

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433462400000",
    "number": "1861872657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3260 HOSPITAL DR",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017808",
            "telephone_number": "907-796-8631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3260 HOSPITAL DR",
            "city": "JUNEAU",
            "state": "AK",
            "postal_code": "998017808",
            "telephone_number": "907-796-8631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST RADIOLOGY CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A",
        "authorized_official_last_name": "SHANLEY",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "907-321-1953",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "AK",
            "license": "5533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1014647",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeast Alaska Urology, LLC
• Southeast Dental Group, PC
• Southeast Foot & Ankle Center Inc
• Southeast Furniture Warehouse, Inc
• Southeast Psychiatry
• Southeast Urgent Care Incorporated
• Southeast Urology LLC
• Southeast Urology, LLC
• Brian Sparks
• Michael Sparks, MSW

• Diagnostic Radiology Physician in Juneau, AK
• Providers in Juneau, AK by specialty
• Diagnostic Radiology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.