Provider Demographics
NPI:1639124274
Name:ADVANCED RADIOLOGY PC
Entity Type:Organization
Organization Name:ADVANCED RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-234-6958
Mailing Address - Street 1:PO BOX 11686
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0128
Mailing Address - Country:US
Mailing Address - Phone:731-300-0352
Mailing Address - Fax:901-753-2896
Practice Address - Street 1:367 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2080
Practice Address - Country:US
Practice Address - Phone:731-661-2000
Practice Address - Fax:901-753-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720053Medicaid
TN3720053Medicare ID - Type Unspecified