Healthcare Provider Details

I. General information

NPI: 1710932553
Provider Name (Legal Business Name): EAST TENNESSEE DIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 OLD WEISGARBER RD STE 120
KNOXVILLE TN
37909-1327
US

IV. Provider business mailing address

PO BOX 11664
KNOXVILLE TN
37939-1664
US

V. Phone/Fax

Practice location:
  • Phone: 865-584-7376
  • Fax: 865-684-2619
Mailing address:
  • Phone: 865-584-7376
  • Fax: 865-540-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL W LANGENBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 865-584-7376