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NPI Code Detail

MEDICARE: RADNOR MEDICAL GROUP, INC.

MEDICARE: RADNOR MEDICAL GROUP, INC.
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
1207Q00000XFamily Medicine Physician
2208000000XPediatrics Physician

General Provider Information

NPI Number : 1891834198
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADNOR MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : PO BOX 24270
Second Line :
City : NASHVILLE
State : TN
Zip : 37202-4270
Country : US
Telephone Number : 615-331-1473
Fax Number : 615-376-0199
Provider Business Practice Location Address
First Line : 5505 EDMONDSON PIKE
Second Line : SUITE 102
City : NASHVILLE
State : TN
Zip : 37211-5869
Country : US
Telephone Number : 615-331-1473
Fax Number : 615-331-6548
Authorized Official
Title or Position : ADMINISTRATOR
Name : LANCE GARDINER
Credential :
Telephone Number : 615-331-1473
Provider Enumeration Date : 02/05/2007
Last Update Date : 07/11/2007

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Directions to “RADNOR MEDICAL GROUP, INC. ” Practice Location

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