Basic Information
| Provider Information | |||||||||
| NPI: | 1649233214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARIAS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MANUEL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ARIAS | ||||||||
| OtherFirstName: | JUAN | ||||||||
| OtherMiddleName: | MANUEL | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11995 SINGLETREE LN | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | EDEN PRAIRIE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553445347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525951100 | ||||||||
| FaxNumber: | 9529423361 | ||||||||
| Practice Location | |||||||||
| Address1: | 9010 SADDLEBACK RD | ||||||||
| Address2: | |||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840984740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525951100 | ||||||||
| FaxNumber: | 9529423361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 05/31/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | M9472 | ID | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 182009-1205 | UT | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3810010512 | 05 | VA | MEDICAID | 000000548183 | 01 | KY | ANTHEM-KCR | OTHER | 2822897 | 05 | OH | MEDICAID | 7100025880 | 05 | KY | MEDICAID | P00403946 | 01 | VA | MEDICARE RAILROAD | OTHER | 3427946000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 2016383 | 01 | PA | HIGHMARK BLUE CROSS/BLUE SHIELD | OTHER | 50017692 | 01 | KY | PASSPORT-KCR | OTHER | 91715 | 01 | KY | SIHO-KCR | OTHER | 102079853 | 05 | PA | MEDICAID | 1649233214 | 05 | VA | MEDICAID |