1285613141 NPI number — SPRINGFIELD RADIOLOGY ASSOCIATES, PC

Table of content: (NPI 1285613141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285613141 NPI number — SPRINGFIELD RADIOLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGFIELD RADIOLOGY ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285613141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3125
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37043-3125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-647-5034
Provider Business Mailing Address Fax Number:
931-552-6663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 PARK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42101-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-796-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRANNICK
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
931-647-5034

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000269735 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4042327 . This is a "BCBS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: CJ8639 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3375149 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO0012 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 020289899 . This is a "DEPT. OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 65940595 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7916327 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com