Healthcare Provider Details

I. General information

NPI: 1295729978
Provider Name (Legal Business Name): RICHMOND RADIOLOGISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S 8TH ST
RICHMOND IN
47374-5441
US

IV. Provider business mailing address

35 S 8TH ST
RICHMOND IN
47374-5441
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-2929
  • Fax: 765-966-2845
Mailing address:
  • Phone: 765-966-2929
  • Fax: 765-966-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number50000783A
License Number StateIN

VIII. Authorized Official

Name: DR. MICHAEL T. BRENDLE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 765-966-2929