MEDICARE: TENNESSEE IMAGING ALLIANCE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1225252091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENNESSEE IMAGING ALLIANCE LLC

Provider Business Mailing Address
First Line	:	1405 HATCHER LN
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3535
Country	:	US
Telephone Number	:	931-388-2848
Fax Number	:	931-388-2858

Provider Business Practice Location Address
First Line	:	1405 HATCHER LN
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3535
Country	:	US
Telephone Number	:	931-388-2848
Fax Number	:	931-388-2858

Authorized Official
Title or Position	:	CONTRACT MANAGER
Name	:	MRS. MICHELLE DOUGLAS
Credential	:
Telephone Number	:	502-477-1815

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	06/20/2008

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