Provider Demographics
NPI:1396704474
Name:OUTPATIENT RADIOLOGY LLC
Entity type:Organization
Organization Name:OUTPATIENT RADIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RHEA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-265-1620
Mailing Address - Street 1:419 SOUTH WASHINGTON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-234-6963
Mailing Address - Fax:307-237-1074
Practice Address - Street 1:419 SOUTH WASHINGTON STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-234-6963
Practice Address - Fax:307-237-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025260001Medicaid
WY116358200Medicaid