Organization
MEMPHIS RADIOLOGICAL, P.C.
Active
Organization
MEMPHIS RADIOLOGICAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE E HANSEN JR. MD (PRESIDENT)
(901) 685-2696
Entity
Organization
Contact information
Practice address
1265 UNION AVE, MEMPHIS, TN 38104-3415
(901) 685-2696
(423) 826-1290
Mailing address
DEPT 24 PO BOX 1000, MEMPHIS, TN 38148
(901) 685-2696
(423) 826-1290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370135
—
TN
01
—
CC0445
RR MEDICARE
TN
Enumeration date
05/23/2005
Last updated
07/21/2022
Update your record
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