Healthcare Provider Details

I. General information

NPI: 1295401602
Provider Name (Legal Business Name): EXPERTUS IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2718 SQUIRREL HOLLOW DR
LINDEN TN
37096-3526
US

IV. Provider business mailing address

2718 SQUIRREL HOLLOW DR
LINDEN TN
37096-3526
US

V. Phone/Fax

Practice location:
  • Phone: 931-589-8901
  • Fax:
Mailing address:
  • Phone: 931-589-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON WEIL
Title or Position: OWNER
Credential:
Phone: 407-459-8845