Provider Demographics
NPI:1578512232
Name:RADIOLOGY CONSULTANTS OF NACOGDOCHES LLP
Entity Type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF NACOGDOCHES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-569-0841
Mailing Address - Street 1:PO BOX 5370
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75608-5370
Mailing Address - Country:US
Mailing Address - Phone:903-663-4800
Mailing Address - Fax:903-663-9960
Practice Address - Street 1:1204 N MOUND ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4027
Practice Address - Country:US
Practice Address - Phone:936-568-8514
Practice Address - Fax:903-663-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112622901Medicaid
TX00LK66Medicare PIN