Healthcare Provider Details

I. General information

NPI: 1679619639
Provider Name (Legal Business Name): PROFESSIONAL IMAGING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 AUSTIN PARK LN
KNOXVILLE TN
37920-8240
US

IV. Provider business mailing address

7238 AUSTIN PARK LN
KNOXVILLE TN
37920-8240
US

V. Phone/Fax

Practice location:
  • Phone: 865-387-7642
  • Fax: 865-573-1701
Mailing address:
  • Phone: 865-387-7642
  • Fax: 865-573-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number72825
License Number StateTN

VIII. Authorized Official

Name: MS. TERESA M BUTLER
Title or Position: CARDIAC SONOGRAPHER
Credential: RDCS
Phone: 865-387-7642