Provider Demographics
NPI:1336504844
Name:RADIANT HEALTHCARE, PC
Entity Type:Organization
Organization Name:RADIANT HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:269-964-3300
Mailing Address - Street 1:1346 COLUMBIA AVE W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3067
Mailing Address - Country:US
Mailing Address - Phone:269-964-3300
Mailing Address - Fax:269-964-3366
Practice Address - Street 1:1346 COLUMBIA AVE W
Practice Address - Street 2:SUITE 101
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3067
Practice Address - Country:US
Practice Address - Phone:269-964-3300
Practice Address - Fax:269-964-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty