Provider Demographics
NPI:1902518236
Name:SOUTHERN RADIOLOGY GROUPS
Entity Type:Organization
Organization Name:SOUTHERN RADIOLOGY GROUPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MONTOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-523-6595
Mailing Address - Street 1:7801 OLD BRANCH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1642
Mailing Address - Country:US
Mailing Address - Phone:202-221-8442
Mailing Address - Fax:202-221-8443
Practice Address - Street 1:1310 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:202-221-8442
Practice Address - Fax:202-221-8443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile