Provider Demographics
NPI:1710481122
Name:HENDERSON RADIOLOGY, INC.
Entity Type:Organization
Organization Name:HENDERSON RADIOLOGY, INC.
Other - Org Name:HENDERSON MEDICAL IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-494-9946
Mailing Address - Street 1:10561 JEFFREYS ST STE 111
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4267
Mailing Address - Country:US
Mailing Address - Phone:702-832-0116
Mailing Address - Fax:
Practice Address - Street 1:10561 JEFFREYS ST STE 111
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4267
Practice Address - Country:US
Practice Address - Phone:702-832-0116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV201810169252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty