Provider Demographics
NPI:1245376581
Name:RADIOGRAPHICS, INC.
Entity type:Organization
Organization Name:RADIOGRAPHICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:901-382-4175
Mailing Address - Street 1:2135 HILLSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38133-6074
Mailing Address - Country:US
Mailing Address - Phone:901-382-4175
Mailing Address - Fax:901-382-2929
Practice Address - Street 1:2135 HILLSHIRE CIR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-6074
Practice Address - Country:US
Practice Address - Phone:901-382-4175
Practice Address - Fax:901-382-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09879015Medicaid
TNP00124998OtherRAILROAD MEDICARE
TN3400835Medicaid
AR167592710Medicaid
AR19810OtherBCBS
TN4073480OtherBCBS
TN4073480OtherBCBS
MS09879015Medicaid
AR19810OtherBCBS
AR167592710Medicaid