Provider Demographics
NPI:1336186139
Name:REGIONAL DIAGNOSTIC SERVICES INC
Entity Type:Organization
Organization Name:REGIONAL DIAGNOSTIC SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:615-347-9347
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-0059
Mailing Address - Country:US
Mailing Address - Phone:615-451-4511
Mailing Address - Fax:615-230-8585
Practice Address - Street 1:314 BLUEBIRD DR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2304
Practice Address - Country:US
Practice Address - Phone:615-347-9347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3790335Medicaid
TN3081506OtherBCBS
TN3790335Medicaid