Provider Demographics
NPI:1124056734
Name:RADIOLOGY CONSULTANTS A PROFESSIONAL CORP
Entity type:Organization
Organization Name:RADIOLOGY CONSULTANTS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-460-1762
Mailing Address - Street 1:PO BOX 70378
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0378
Mailing Address - Country:US
Mailing Address - Phone:907-456-2784
Mailing Address - Fax:
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5925
Practice Address - Country:US
Practice Address - Phone:907-458-5660
Practice Address - Fax:903-663-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKGR0138Medicaid
AK0000WCGRLMedicare ID - Type Unspecified