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General NPI Number Information
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NPI Number | 1386832368
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Entity Type | Organization
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Legal Business Name | LIFESCAN TENNESSEE, LLC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 830 SUNCREST DR UNIT 2
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City | GRAY
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State | TN
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Zip | 37615-3424
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Country | US
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Telephone | 423-477-3026
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Fax | 423-477-2686
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Provider Business Mailing Address
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Address Line | 701 N STATE OF FRANKLIN RD SUITE 1
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City | JOHNSON CITY
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State | TN
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Zip | 37604-3645
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Country | US
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Telephone | 423-477-3026
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Fax | 423-477-2686
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT GREGORY
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Credential |
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Telephone | 423-477-3026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | ODC0000000042
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License Number State | TN
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