Provider Demographics
NPI:1457936254
Name:RAD MEDICAL LLC
Entity Type:Organization
Organization Name:RAD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDGEPETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-417-5518
Mailing Address - Street 1:103 BIRDIE TRL
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-5106
Mailing Address - Country:US
Mailing Address - Phone:662-417-5518
Mailing Address - Fax:
Practice Address - Street 1:103 BIRDIE TRL
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-5106
Practice Address - Country:US
Practice Address - Phone:662-417-5518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile