Basic Information
| Provider Information | |||||||||
| NPI: | 1437119328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATES IN DIAGNOSTIC RADIOLOGY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3145 | ||||||||
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| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462063145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552068406 | ||||||||
| FaxNumber: | 8558238132 | ||||||||
| Practice Location | |||||||||
| Address1: | 2333 MCCALLIE AVE | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374043258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234931387 | ||||||||
| FaxNumber: | 4235531224 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | KILPATRICK | ||||||||
| AuthorizedOfficialFirstName: | SUE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 4235531220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3373921 | 05 | TN | MEDICAID | 000038002 | 05 | AL | MEDICAID | 2006511 | 01 | TN | BC/BS OF TN | OTHER | 221822 | 01 | TN | BLACK LUNG | OTHER | 8901079 | 05 | NC | MEDICAID |