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General NPI Number Information
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NPI Number | 1528193943
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Entity Type | Organization
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Legal Business Name | BRISTOL IMAGING CENTER, LLC.
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1230 VOLUNTEER PKWY
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City | BRISTOL
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State | TN
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Zip | 37620-4628
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Country | US
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Telephone | 423-844-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 AMERICAN WAY
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City | KINGSPORT
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State | TN
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Zip | 37660-5882
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO, BRISTOL REGIONAL MEDICAL CENTE
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Name | MICHAEL K. LAUF
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Credential |
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Telephone | 423-844-4200
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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 |
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License Number State | TN
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