Provider Demographics
NPI:1699707174
Name:OASIS RADIOLOGY
Entity type:Organization
Organization Name:OASIS RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-775-8066
Mailing Address - Street 1:DEPT LA 21607
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91185-1607
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-1639
Practice Address - Street 1:47-111 MONROE ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6739
Practice Address - Country:US
Practice Address - Phone:760-775-8066
Practice Address - Fax:760-775-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Multi-Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65381ZOtherBS
CAGR0101543Medicaid
CAZZZ67699ZOtherBLUE SHIELD
CAGR0101544Medicaid
CAZZZ67698ZOtherBLUE SHIELD
CAGR0101540Medicaid
CAGR0101542Medicaid
CAGR0101541Medicaid
CAZZZ67697ZOtherBLUE SHIELD
CAZZZ67700ZOtherBLUE SHIELD
CAZZZ67700ZOtherBLUE SHIELD
CAGR0101543Medicaid