NPIMap

Organization Active NPI

Southeastern Radiology PA

  • Diagnostic Radiology Physician
  • Greensboro, NC
National Provider Identifier
1669476453
Registry record updated Dec 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
400555 Issued in NC
Legal business name
SOUTHEASTERN RADIOLOGY PA
Practice address
3801 W Market St
Greensboro, NC 27407-1301
Phone
(336) 852-3300
Fax
(336) 852-0651
NPI assigned
Jun 9, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Dallas Aaron Smith Jr., MDNPI 1972507655
Title
President
Phone
(336) 852-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X 400555 NC Primary

Addresses

Primary practice location

3801 W Market St
Greensboro, NC 27407-1301

Mailing address

3801 W Market St
Greensboro, NC 27407-1301
Phone (336) 852-3300

Other identifiers 1

IdentifierTypeStateIssuer
890252KMedicaidNC

National Provider Directory

National Provider Directory

Locations

3801 W Market St
Greensboro, NC 27407
Phone (336) 852-3300

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228694400000",
    "number": "1669476453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 W MARKET ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071301",
            "telephone_number": "336-852-3300",
            "fax_number": "336-852-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 W MARKET ST",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071301",
            "telephone_number": "336-852-3300",
            "fax_number": "336-852-0651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEASTERN RADIOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2008-12-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DALLAS",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-852-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "400555",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890252K",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.