Healthcare Provider Details

I. General information

NPI: 1457350514
Provider Name (Legal Business Name): MEMPHIS RADIOLOGICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1388 MADISON AVE
MEMPHIS TN
38104-2327
US

IV. Provider business mailing address

PO BOX 341881
MEMPHIS TN
38184-1881
US

V. Phone/Fax

Practice location:
  • Phone: 901-276-6413
  • Fax:
Mailing address:
  • Phone: 901-291-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: DR. RICHARD M FLEMING
Title or Position: MANAGING DIRECTOR
Credential: MD
Phone: 901-685-2696