Provider Demographics
NPI:1609836584
Name:PLAZA RADIOLOGY,LLC
Entity Type:Organization
Organization Name:PLAZA RADIOLOGY,LLC
Other - Org Name:CHATTANOOGA IMAGING
Other - Org Type:Doing Business As
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 3146
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3146
Mailing Address - Country:US
Mailing Address - Phone:855-206-8406
Mailing Address - Fax:855-823-8132
Practice Address - Street 1:1710 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3127
Practice Address - Country:US
Practice Address - Phone:423-553-1220
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
AL008603740Medicaid
TN3716643Medicaid
TN833340OtherBLACK LUNG
TN0198087OtherBC/BS OF TN
TN3716643Medicare PIN
TN833340OtherBLACK LUNG