Provider Demographics
NPI:1538106810
Name:HENDERSONVILLE RADIOLOGICAL CONSULTANTS, P.A.
Entity Type:Organization
Organization Name:HENDERSONVILLE RADIOLOGICAL CONSULTANTS, P.A.
Other - Org Name:HENDERSONVILLE RADIOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:828-693-0294
Mailing Address - Street 1:807 N JUSTICE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3409
Mailing Address - Country:US
Mailing Address - Phone:828-693-0294
Mailing Address - Fax:828-697-5738
Practice Address - Street 1:807 N JUSTICE ST
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3409
Practice Address - Country:US
Practice Address - Phone:828-693-0294
Practice Address - Fax:828-697-5738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPA564Medicaid
NC01756OtherBCBSNC GROUP
NC8901756Medicaid
NC8901756Medicaid
NC204341Medicare ID - Type UnspecifiedGROUP