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General NPI Number Information
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NPI Number | 1487705760
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Entity Type | Organization
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Legal Business Name | RAD-ONE, PA
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 7420 GUTHRIE DR N
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5876
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Country | US
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Telephone | 662-349-4321
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Fax | 662-996-1533
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Provider Business Mailing Address
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Address Line | 618 FREDERICK DR
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City | CLEVELAND
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State | MS
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Zip | 38732-2006
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Country | US
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Telephone | 716-435-5044
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Fax |
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Authorized Official
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Title or Position | MEDICAL BILLING COORDINATOR
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Name | YVETTE M REYNOLDS
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Credential |
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Telephone | 716-435-5044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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