Provider Demographics
NPI:1396737961
Name:RADIOLOGY ASSOCIATES OF ABILENE PA
Entity type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF ABILENE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-677-2201
Mailing Address - Street 1:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2898
Mailing Address - Country:US
Mailing Address - Phone:325-677-2201
Mailing Address - Fax:325-677-7641
Practice Address - Street 1:401 CYPRESS ST
Practice Address - Street 2:# 110
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5122
Practice Address - Country:US
Practice Address - Phone:325-677-2201
Practice Address - Fax:325-677-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00C414OtherBLUECROSSBLUE SHIELD
TX127266804Medicaid
TX00C414Medicare PIN