Provider Demographics
NPI:1457367880
Name:FRANKLIN COUNTY DIAGNOSTICS
Entity Type:Organization
Organization Name:FRANKLIN COUNTY DIAGNOSTICS
Other - Org Name:WINCHESTER IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:COUNCILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-962-2272
Mailing Address - Street 1:25 VETERANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324
Mailing Address - Country:US
Mailing Address - Phone:931-962-2273
Mailing Address - Fax:961-962-2202
Practice Address - Street 1:25 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324
Practice Address - Country:US
Practice Address - Phone:931-962-2273
Practice Address - Fax:961-962-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00531543174400000X
TN009260261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3791646Medicaid
TN3791646Medicare PIN
TNB03898Medicare UPIN