Provider Demographics
NPI:1891782983
Name:EVANSVILLE RADIOLOGY, P.C.
Entity Type:Organization
Organization Name:EVANSVILLE RADIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-422-3254
Mailing Address - Street 1:350 W COLUMBIA ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-1782
Mailing Address - Country:US
Mailing Address - Phone:812-422-3254
Mailing Address - Fax:812-426-6388
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:SUITE 420
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1782
Practice Address - Country:US
Practice Address - Phone:812-422-3254
Practice Address - Fax:812-426-6388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65903163Medicaid
IN100282640AMedicaid
IL0001891782983Medicaid
KYN198447OtherWELLCARE OF KY
KY50003548OtherPASSPORT
IL0001891782983Medicaid