Provider Demographics
NPI:1154400935
Name:RADIOLOGY ASSOCIATES OF IRON MOUNTAIN P L C
Entity type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF IRON MOUNTAIN P L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:TO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-776-5569
Mailing Address - Street 1:1721 S STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3637
Mailing Address - Country:US
Mailing Address - Phone:906-774-1313
Mailing Address - Fax:
Practice Address - Street 1:1721 S STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3637
Practice Address - Country:US
Practice Address - Phone:906-774-1313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI32880500Medicaid
MI7717OtherCAPE MEDICAL PLAN
MIXX13511OtherHEALTHPLUS OF MI
MI561429OtherSELECTCARE
MICF8537OtherRAILROAD MEDICARE
MI13645400OtherUS DEPT OF LABOR WORKCOMP
MI020079OtherMIDWEST HEALTH PLAN
MI0B21023OtherBLUE CROSS BLUE SHIELD MI
MI95436OtherPREFERRED ONE
MI0M87540Medicare ID - Type Unspecified