Healthcare Provider Details

I. General information

NPI: 1417238577
Provider Name (Legal Business Name): TENNESSEE IMAGING CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 NORTHCREST DR
SPRINGFIELD TN
37172-3927
US

IV. Provider business mailing address

P.O. BOX 305172 DEPT 98
NASHVILLE TN
37230-5172
US

V. Phone/Fax

Practice location:
  • Phone: 615-384-1531
  • Fax: 931-552-6663
Mailing address:
  • Phone: 931-647-5034
  • Fax: 931-552-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: BARRY ALLEN
Title or Position: DIRECTOR
Credential: MD
Phone: 615-384-1531