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NPI Code Detail

MEDICARE: SOUTHEASTERN RADIOLOGY PA

MEDICARE: SOUTHEASTERN RADIOLOGY PA
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
12085R0202XDiagnostic Radiology Physician400555NC

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 : 1669476453
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN RADIOLOGY PA
Provider Business Mailing Address
First Line : 3801 W MARKET ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27407-1301
Country : US
Telephone Number : 336-852-3300
Fax Number : 336-852-0651
Provider Business Practice Location Address
First Line : 3801 W MARKET ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27407-1301
Country : US
Telephone Number : 336-852-3300
Fax Number : 336-852-0651
Authorized Official
Title or Position : PRESIDENT
Name : DR. DALLAS AARON SMITH JR.
Credential : MD
Telephone Number : 336-852-3300
Provider Enumeration Date : 06/09/2005
Last Update Date : 12/08/2008

Similar Medicare Providers

1912901687 — DR. CHERYL A VIGLIONE MD
Practice Location Address:
3801 W MARKET ST
GREENSBORO, NC
27407-1301
Practice Phone: 336-852-3300
Practice Fax: 336-852-0651
1780680389 — LEWIS ROGATNICK MD
Practice Location Address:
3801 W MARKET ST
GREENSBORO, NC
27407-1301
Practice Phone: 336-883-0029
Practice Fax:
1306847660 — DAVID MAURICE HURST MD
Practice Location Address:
3801 W MARKET ST
GREENSBORO, NC
27407-1301
Practice Phone: 336-852-3300
Practice Fax: 336-852-0651
1114903176 — HENRY TUCKER GILBERT MD
Practice Location Address:
3801 W MARKET ST
GREENSBORO, NC
27407-1301
Practice Phone: 336-852-3300
Practice Fax: 336-852-0651
1417991613 — DR. ROBERT MIDDLETON FOSTER JR. M.D.
Practice Location Address:
3801 W MARKET ST
GREENSBORO, NC
27407-1301
Practice Phone: 336-883-0029
Practice Fax:
1912002502 — DR. AARON MICHAEL WILLIAMS DC
Practice Location Address:
3831 W MARKET ST
GREENSBORO, NC
27407-1301
Practice Phone: 336-299-3037
Practice Fax: 336-299-3066

Directions to “SOUTHEASTERN RADIOLOGY PA ” Practice Location

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