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NPI Code Detail

MEDICARE: MEMPHIS RADIOLOGICAL, P.C.

MEDICARE: MEMPHIS RADIOLOGICAL, P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianTN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC0445OTHERTNRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639172851
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMPHIS RADIOLOGICAL, P.C.
Provider Business Mailing Address
First Line : DEPT 24 PO BOX 1000
Second Line :
City : MEMPHIS
State : TN
Zip : 38148
Country : US
Telephone Number : 901-685-2696
Fax Number : 423-826-1290
Provider Business Practice Location Address
First Line : 1265 UNION AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-3415
Country : US
Telephone Number : 901-685-2696
Fax Number : 423-826-1290
Authorized Official
Title or Position : PRESIDENT
Name : DR. DALE E HANSEN JR.
Credential : MD
Telephone Number : 901-685-2696
Provider Enumeration Date : 05/23/2005
Last Update Date : 07/21/2022

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1376546150 — MICHAEL D. KOPLON M.D.
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1841293743 — DR. DALE E HANSEN JR. MD
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Practice Fax:
1104829845 — DR. JAMES W BOALS SR. MD
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1265 UNION AVE
MEMPHIS, TN
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