Healthcare Provider Details

I. General information

NPI: 1093920787
Provider Name (Legal Business Name): FENTRESS HEALTH SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W CENTRAL AVENUE
JAMESTOWN TN
38556
US

IV. Provider business mailing address

PO BOX 51923
KNOXVILLE TN
37950-1923
US

V. Phone/Fax

Practice location:
  • Phone: 931-752-2273
  • Fax:
Mailing address:
  • Phone: 865-531-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number34
License Number StateTN

VIII. Authorized Official

Name: BALEY F ALLRED III
Title or Position: CHARIMAN OF THE BOARD
Credential:
Phone: 931-752-2273