Provider Demographics
NPI:1538110846
Name:BEVERLY RADIOLOGY ASSOCIATES, INC.
Entity type:Organization
Organization Name:BEVERLY RADIOLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KEEFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-927-6385
Mailing Address - Street 1:85 HERRICK ST
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1776
Mailing Address - Country:US
Mailing Address - Phone:978-927-6385
Mailing Address - Fax:978-927-3534
Practice Address - Street 1:85 HERRICK ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1776
Practice Address - Country:US
Practice Address - Phone:978-927-6385
Practice Address - Fax:978-927-3534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9711031Medicaid
MA9711031Medicaid