MEDICARE: WINGATE MOBILE, INC.

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	2471S1302X	Sonography Radiologic Technologist	112229	TN
2	247100000X	Radiologic Technologist	346808	TN

General Provider Information

NPI Number	:	1316201882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINGATE MOBILE, INC.

Provider Business Mailing Address
First Line	:	323 SAVANNAH RDG
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37127-8331
Country	:	US
Telephone Number	:	615-671-9808
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 SAVANNAH RDG
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37127-8331
Country	:	US
Telephone Number	:	615-671-9808
Fax Number	:

Authorized Official
Title or Position	:	CEO/RT
Name	:	BRANDON DEAN WINGATE
Credential	:	R.T.
Telephone Number	:	615-671-9808

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	07/10/2012

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