Basic Information
Provider Information | |||||||||
NPI: | 1063528461 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | RADIOLOGY ASSOCIATES OF DENISON, LLP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1302 HWY 91 NORTH | ||||||||
Address2: |   | ||||||||
City: | DENISON | ||||||||
State: | TX | ||||||||
PostalCode: | 75020 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9034651857 | ||||||||
FaxNumber: | 9033278023 | ||||||||
Practice Location | |||||||||
Address1: | 504 LIPSCOMB ST | ||||||||
Address2: | RADIOLOGY DEPT | ||||||||
City: | BONHAM | ||||||||
State: | TX | ||||||||
PostalCode: | 754184028 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9035838585 | ||||||||
FaxNumber: | 9036407601 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/21/2006 | ||||||||
LastUpdateDate: | 12/20/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HENSLEE | ||||||||
AuthorizedOfficialFirstName: | DOROTHY | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | CEO/PRACTICE MGR | ||||||||
AuthorizedOfficialTelephone: | 9034659508 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 112627801 | 05 | TX |   | MEDICAID |