Healthcare Provider Details

I. General information

NPI: 1720701543
Provider Name (Legal Business Name): MEMPHIS RADIOLOGICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 POPLAR AVE STE 100
MEMPHIS TN
38119-4840
US

IV. Provider business mailing address

P O BOX 1000 DEPT 24
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-387-2340
  • Fax:
Mailing address:
  • Phone: 901-685-2696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM ASHER
Title or Position: COO
Credential:
Phone: 901-685-2696