Provider Demographics
NPI:1609921857
Name:RADIOLOGY ASSOCIATES OF OTTUMWA, P.C.
Entity type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF OTTUMWA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCCARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:641-682-5453
Mailing Address - Street 1:1005 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6413
Mailing Address - Country:US
Mailing Address - Phone:641-682-5453
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 1 NORTH
Practice Address - Street 2:
Practice Address - City:KEOSAUQUA
Practice Address - State:IA
Practice Address - Zip Code:52565
Practice Address - Country:US
Practice Address - Phone:641-682-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA8188177Medicaid
CP7547OtherRAILROAD MEDICARE
IA31256Medicare ID - Type Unspecified