Provider Demographics
NPI:1154790772
Name:SILVER CREEK RADIOLOGY PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:SILVER CREEK RADIOLOGY PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PIATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-451-0780
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0032
Mailing Address - Country:US
Mailing Address - Phone:669-888-0001
Mailing Address - Fax:669-888-0551
Practice Address - Street 1:2365 QUIMBY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1337
Practice Address - Country:US
Practice Address - Phone:650-427-9887
Practice Address - Fax:650-618-5198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty