Provider Demographics
NPI:1407014590
Name:AMERICAN TELERADIOLOGY INC
Entity Type:Organization
Organization Name:AMERICAN TELERADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-244-3156
Mailing Address - Street 1:PO BOX 701506
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-1506
Mailing Address - Country:US
Mailing Address - Phone:972-210-7002
Mailing Address - Fax:972-939-1293
Practice Address - Street 1:3208 COLE AVE
Practice Address - Street 2:SUITE 1208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1349
Practice Address - Country:US
Practice Address - Phone:214-244-3156
Practice Address - Fax:214-880-0977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL89902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1841255668Medicare UPIN