Healthcare Provider Details

I. General information

NPI: 1245376581
Provider Name (Legal Business Name): RADIOGRAPHICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 HILLSHIRE CIR
MEMPHIS TN
38133-6074
US

IV. Provider business mailing address

2135 HILLSHIRE CIR
MEMPHIS TN
38133-6074
US

V. Phone/Fax

Practice location:
  • Phone: 901-382-4175
  • Fax: 901-382-2929
Mailing address:
  • Phone: 901-382-4175
  • Fax: 901-382-2929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number StateTN

VIII. Authorized Official

Name: GLENN LEE JOHNSON
Title or Position: VICE PRESIDENT
Credential: R.T.
Phone: 901-382-4175