Provider Demographics
NPI:1720476088
Name:RADIOGRAPHICS, INC
Entity type:Organization
Organization Name:RADIOGRAPHICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:901-382-4175
Mailing Address - Street 1:2135 HILLSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-6074
Mailing Address - Country:US
Mailing Address - Phone:901-382-4175
Mailing Address - Fax:901-382-2929
Practice Address - Street 1:2135 HILLSHIRE CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-6074
Practice Address - Country:US
Practice Address - Phone:901-382-4175
Practice Address - Fax:901-382-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018140Medicaid
TN103G475983Medicare PIN