Healthcare Provider Details

I. General information

NPI: 1316201882
Provider Name (Legal Business Name): WINGATE MOBILE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 SAVANNAH RDG
MURFREESBORO TN
37127-8331
US

IV. Provider business mailing address

323 SAVANNAH RDG
MURFREESBORO TN
37127-8331
US

V. Phone/Fax

Practice location:
  • Phone: 615-671-9808
  • Fax:
Mailing address:
  • Phone: 615-671-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number346808
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number112229
License Number StateTN

VIII. Authorized Official

Name: BRANDON DEAN WINGATE
Title or Position: CEO/RT
Credential: R.T.
Phone: 615-671-9808