Organization
JACKSON RADIOLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY BRUNO M.D. (PRESIDENT)
(731) 541-6174
Entity
Organization
Contact information
Practice address
620 SKYLINE DR, JACKSON, TN 38301-3901
(731) 541-6174
(731) 425-6274
Mailing address
1947 MADISON ST, STE A, CLARKSVILLE, TN 37043-8062
(316) 685-2371
(931) 552-6663
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085N0904X
Nuclear Radiology Physician
—
—
2085P0229X
Pediatric Radiology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0203X
Therapeutic Radiology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
2085R0205X
Radiological Physics Physician
—
—
2085U0001X
Diagnostic Ultrasound Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315752
MEDICARE PIN
CO
05
—
3729238
—
TN
01
—
CG710B
NEVADA MEDICARE
—
01
—
CG710C
PALMETTO HAWAII
HI
01
—
CG753Z
CALIFORNIA MDCR
CA
01
—
DD9799
RAILROAD MEDICARE
—
Enumeration date
07/11/2006
Last updated
03/11/2024
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