Provider Demographics
NPI:1295753929
Name:CORINTH NUCLEAR IMAGING RESOURCE PLLC
Entity type:Organization
Organization Name:CORINTH NUCLEAR IMAGING RESOURCE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-734-0232
Mailing Address - Street 1:6505 W PARK BLVD
Mailing Address - Street 2:306-262
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6208
Mailing Address - Country:US
Mailing Address - Phone:214-734-0232
Mailing Address - Fax:
Practice Address - Street 1:4851 S INTERSTATE 35 E
Practice Address - Street 2:SUITE 101
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2348
Practice Address - Country:US
Practice Address - Phone:940-270-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Not Answered207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Not Answered2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B0090OtherBC IND
TX0098GHOtherBC GR
TX8B0090OtherBC IND
TXE59200Medicare UPIN