Provider Demographics
NPI:1417062365
Name:SHERMAN RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:SHERMAN RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENSLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-892-1131
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0340
Mailing Address - Country:US
Mailing Address - Phone:903-892-1131
Mailing Address - Fax:903-327-8023
Practice Address - Street 1:5016 S US HIGHWAY 75
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4584
Practice Address - Country:US
Practice Address - Phone:903-892-1131
Practice Address - Fax:903-327-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083733801Medicaid
OK100750470AMedicaid
TX083733801Medicaid