Healthcare Provider Details

I. General information

NPI: 1851641567
Provider Name (Legal Business Name): TRINITY MOBILE X-RAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 WADE SPRINGS RD
MURFREESBORO TN
37130-8719
US

IV. Provider business mailing address

6431 WADE SPRINGS RD
MURFREESBORO TN
37130-8719
US

V. Phone/Fax

Practice location:
  • Phone: 615-522-1094
  • Fax:
Mailing address:
  • Phone: 615-522-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TIMOTHY LEE RUSSELL
Title or Position: OWNER/OPERATOR
Credential: R.T.
Phone: 615-522-1094