Basic Information
| Provider Information | |||||||||
| NPI: | 1376792804 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLINICAL RADIOLOGISTS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1000 DEPT 543 | ||||||||
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| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002747777 | ||||||||
| FaxNumber: | 9017592896 | ||||||||
| Practice Location | |||||||||
| Address1: | 631 R.B. WILSON DR | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002747777 | ||||||||
| FaxNumber: | 9017532896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 09/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | CHEATHAM | ||||||||
| AuthorizedOfficialFirstName: | BEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8002747777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD0000009586 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.