Provider Demographics
NPI:1720085855
Name:MED-RAY, INC.
Entity Type:Organization
Organization Name:MED-RAY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT OF MED-RAY, INC.
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-892-9729
Mailing Address - Street 1:PO BOX 21891
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0891
Mailing Address - Country:US
Mailing Address - Phone:423-892-9729
Mailing Address - Fax:423-648-9042
Practice Address - Street 1:6111A HERITAGE PARK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-3665
Practice Address - Country:US
Practice Address - Phone:423-892-9729
Practice Address - Fax:423-648-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NOT REQUIRED335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN702010734OtherCARITEN SENIOR HEALTH
GA000644091AMedicaid
TN3075999OtherBLUE CROSS BLUE SHIELD
TN100029291OtherPHP OF TENNESSEE
TN3402061Medicaid
GA000644091AMedicaid
TN3402061Medicaid
TN702010734OtherCARITEN SENIOR HEALTH
GA63KBCCHMedicare ID - Type UnspecifiedGA MEDICARE
TN3402061Medicare PIN