Healthcare Provider Details

I. General information

NPI: 1104860857
Provider Name (Legal Business Name): BEDFORD RADIOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2257 WILMA RUDOLPH BLVD SUITE D
CLARKSVILLE TN
37040-6194
US

IV. Provider business mailing address

250 E CARMEL DR SUITE A
CARMEL IN
46032-2635
US

V. Phone/Fax

Practice location:
  • Phone: 317-660-1485
  • Fax: 317-282-0589
Mailing address:
  • Phone: 317-660-1485
  • Fax: 317-282-0589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L WHITE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 317-660-1485