Basic Information
| Provider Information | |||||||||
| NPI: | 1750337143 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIOLOGY ASSOCIATES OF OXFORD - PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 791 WALNUT KNOLL LN | ||||||||
| Address2: | 2ND FL | ||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380188839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017557001 | ||||||||
| FaxNumber: | 9017532896 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 S LAMAR BLVD | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386555373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622328100 | ||||||||
| FaxNumber: | 9017532896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROTH | ||||||||
| AuthorizedOfficialFirstName: | STUART | ||||||||
| AuthorizedOfficialMiddleName: | TODD | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 6622328158 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00115759 | 05 | MS | MEDICAID |