Basic Information
| Provider Information | |||||||||
| NPI: | 1942823265 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INHOME RADIOLOGY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2932 PUMP HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN BRK | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352431857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059996786 | ||||||||
| FaxNumber: | 2058768063 | ||||||||
| Practice Location | |||||||||
| Address1: | 2932 PUMP HOUSE RD | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN BRK | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352431857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059996786 | ||||||||
| FaxNumber: | 2058768063 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2020 | ||||||||
| LastUpdateDate: | 05/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | TRIANTOS | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2059996786 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.