Healthcare Provider Details

I. General information

NPI: 1891782983
Provider Name (Legal Business Name): EVANSVILLE RADIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W COLUMBIA ST SUITE 420
EVANSVILLE IN
47710-1782
US

IV. Provider business mailing address

350 W COLUMBIA ST SUITE 420
EVANSVILLE IN
47710-1782
US

V. Phone/Fax

Practice location:
  • Phone: 812-422-3254
  • Fax: 812-426-6388
Mailing address:
  • Phone: 812-422-3254
  • Fax: 812-426-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEE HOAGLAND
Title or Position: PRESIDENT
Credential: MD
Phone: 812-422-3254