NPIMap

Organization Active NPI

Intervasc at Bay Radiology, LLC

  • Vascular & Interventional Radiology Physician
  • Panama City, FL
National Provider Identifier
1942495916
Registry record updated Aug 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
INTERVASC AT BAY RADIOLOGY, LLC
Practice address
527 N. Palo Alto Ave.
Panama City, FL 32401-3639
Phone
(850) 873-3990
Fax
(850) 873-3974
NPI assigned
Sep 12, 2007
Organization subpart
Yes
Parent organization
BAY RADIOLOGY ASSOCIATES, PLAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 18, 2014

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

Authorized official

Name
Dr. Lloyd G. Logue, D.O.
Title
Ceo
Phone
(850) 747-4905

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0204X Primary

Addresses

Primary practice location

527 N. Palo Alto Ave.
Panama City, FL 32401-3639

Mailing address

PO Box 1770
Panama City, FL 32402-1770
Phone (850) 747-4905

Other identifiers 2

IdentifierTypeStateIssuer
279907300MedicaidFL
98028OtherFLBCBS

National Provider Directory

National Provider Directory
Part of
Bay Radiology Associate

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1189555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408320000000",
    "number": "1942495916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1770",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324021770",
            "telephone_number": "850-747-4905",
            "fax_number": "850-747-4907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "527 N. PALO ALTO AVE.",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324013639",
            "telephone_number": "850-873-3990",
            "fax_number": "850-873-3974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVASC AT BAY RADIOLOGY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAY RADIOLOGY ASSOCIATES, PL",
        "enumeration_date": "2007-09-12",
        "last_updated": "2014-08-18",
        "status": "A",
        "authorized_official_last_name": "LOGUE",
        "authorized_official_first_name": "LLOYD",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-747-4905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279907300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "98028",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Panama City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; 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.