Provider Demographics
NPI:1104881747
Name:VALLEY RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:VALLEY RADIOLOGICAL ASSOCIATES MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:RACKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-261-7880
Mailing Address - Street 1:PO BOX 3222
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-0293
Mailing Address - Country:US
Mailing Address - Phone:707-261-7821
Mailing Address - Fax:707-256-3508
Practice Address - Street 1:10 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9554
Practice Address - Country:US
Practice Address - Phone:707-963-6570
Practice Address - Fax:707-967-5623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0005532Medicaid
CAGR0005530Medicaid
CAGR0005534Medicaid
CAZZZ98653ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAZZZ23296ZMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAGR0005534Medicaid
CAGR0005530Medicaid
CAZZZ86571ZMedicare PIN