Provider Demographics
NPI:1871538504
Name:DIAGNOSTIC RADIOLOGY ASSOCIATES LLC
Entity type:Organization
Organization Name:DIAGNOSTIC RADIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-882-0432
Mailing Address - Street 1:1201 MICKELSON DR STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7253
Mailing Address - Country:US
Mailing Address - Phone:605-882-0432
Mailing Address - Fax:605-882-0978
Practice Address - Street 1:1201 MICKELSON DR STE 2
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-7253
Practice Address - Country:US
Practice Address - Phone:605-882-0432
Practice Address - Fax:605-882-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0006893OtherBCBS - GROUP
SDCJ5800Medicare ID - Type UnspecifiedRAILROAD MCR - GROUP
SD0006893OtherBCBS - GROUP