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NPI Code Detail

MEDICARE: MEMPHIS RADIOLOGICAL, PC

MEDICARE: MEMPHIS RADIOLOGICAL, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085N0904XNuclear Radiology PhysicianTN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457350514
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEMPHIS RADIOLOGICAL, PC
Provider Business Mailing Address
First Line : PO BOX 341881
Second Line :
City : MEMPHIS
State : TN
Zip : 38184-1881
Country : US
Telephone Number : 901-291-2400
Fax Number :
Provider Business Practice Location Address
First Line : 1388 MADISON AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-2327
Country : US
Telephone Number : 901-276-6413
Fax Number :
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : DR. RICHARD M FLEMING
Credential : MD
Telephone Number : 901-685-2696
Provider Enumeration Date : 07/20/2005
Last Update Date : 07/21/2022

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