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General NPI Number Information
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NPI Number | 1407967565
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN MOBILE IMAGING LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 5004 BAYBERRY DR
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City | KNOXVILLE
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State | TN
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Zip | 37921-1401
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Country | US
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Telephone | 865-216-0618
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Fax | 423-765-0465
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Provider Business Mailing Address
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Address Line | 1137 ANDREW BROOK LN
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City | KNOXVILLE
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State | TN
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Zip | 37923-1591
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Country | US
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Telephone | 865-216-0618
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Fax | 865-637-6376
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Authorized Official
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Title or Position | OWNER
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Name | MISS JULIE M WATSON
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Credential |
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Telephone | 865-216-0618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | NA
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License Number State | TN
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