Provider Demographics
NPI:1215364500
Name:GRAHAM RADIOLOGY
Entity Type:Organization
Organization Name:GRAHAM RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-549-3400
Mailing Address - Street 1:1301 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-4240
Mailing Address - Country:US
Mailing Address - Phone:940-549-3400
Mailing Address - Fax:940-521-5156
Practice Address - Street 1:1301 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4240
Practice Address - Country:US
Practice Address - Phone:940-549-3400
Practice Address - Fax:940-521-5156
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAHAM REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty