Healthcare Provider Details

I. General information

NPI: 1891735247
Provider Name (Legal Business Name): ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 PARKSIDE DR STE 204
KNOXVILLE TN
37934-2658
US

IV. Provider business mailing address

PO BOX 11167
KNOXVILLE TN
37939-1167
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-7376
  • Fax: 865-777-6749
Mailing address:
  • Phone: 865-584-7376
  • Fax: 865-540-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateTN

VIII. Authorized Official

Name: MICHAEL W LANGENBERG
Title or Position: PRACTICE ADMINISTRATOR
Credential: CPA
Phone: 865-584-7376