Provider Demographics
NPI:1437119328
Name:ASSOCIATES IN DIAGNOSTIC RADIOLOGY INC
Entity Type:Organization
Organization Name:ASSOCIATES IN DIAGNOSTIC RADIOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-553-1220
Mailing Address - Street 1:PO BOX 3145
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3145
Mailing Address - Country:US
Mailing Address - Phone:855-206-8406
Mailing Address - Fax:855-823-8132
Practice Address - Street 1:2333 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3258
Practice Address - Country:US
Practice Address - Phone:423-493-1387
Practice Address - Fax:423-553-1224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373921Medicaid
AL000038002Medicaid
TN2006511OtherBC/BS OF TN
TN221822OtherBLACK LUNG
NC8901079Medicaid
TN2006511OtherBC/BS OF TN
AL000038002Medicaid