Provider Demographics
NPI:1831141068
Name:NORTHERN NEVADA RADIOLOGISTS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NORTHERN NEVADA RADIOLOGISTS A PROFESSIONAL CORPORATION
Other - Org Name:CHURCHILL RADIOLOGY CONSULTANTS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:HOUSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-423-3151
Mailing Address - Street 1:PO BOX 32364
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2364
Mailing Address - Country:US
Mailing Address - Phone:865-531-6070
Mailing Address - Fax:865-531-2722
Practice Address - Street 1:801 E WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-3052
Practice Address - Country:US
Practice Address - Phone:775-423-3151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVWCGXBMedicare PIN