Provider Demographics
NPI:1063640514
Name:RED BANK RADIOLOGY, P.C.
Entity type:Organization
Organization Name:RED BANK RADIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEDICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-989-1894
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-1446
Mailing Address - Country:US
Mailing Address - Phone:615-989-1894
Mailing Address - Fax:615-989-1956
Practice Address - Street 1:158 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TN
Practice Address - Zip Code:37030-1083
Practice Address - Country:US
Practice Address - Phone:615-989-1894
Practice Address - Fax:615-989-1956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA40422Medicare UPIN