Organization
RADIOLOGY ASSOCIATES OF TALLAHASSEE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R DETELICH (CEO)
(850) 878-4127
Entity
Organization
Contact information
Practice address
1600 PHILLIPS RD, TALLAHASSEE, FL 32308-5304
(850) 878-4127
(850) 878-0337
Mailing address
PO BOX 1678, TALLAHASSEE, FL 32302-1678
(850) 878-4102
(850) 942-4155
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
2471C3401X
Computed Tomography Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00060
BCBS
FL
05
—
053297500
—
FL
05
—
053297501
—
FL
05
—
053297504
—
FL
05
—
053297505
—
FL
05
—
300037169A
—
GA
05
—
N4026
—
FL
Enumeration date
05/11/2006
Last updated
03/14/2014
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