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General NPI Number Information
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NPI Number | 1962124883
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Entity Type | Organization
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Legal Business Name | MOSAIC BREAST IMAGING PLLC
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Dates
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Enumeration Date | 09/16/2022
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 1450 DOWELL SPRINGS BLVD STE 110
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City | KNOXVILLE
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State | TN
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Zip | 37909-2443
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Country | US
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Telephone | 865-607-2692
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Fax |
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Provider Business Mailing Address
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Address Line | 6604 SHERWOOD DR
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City | KNOXVILLE
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State | TN
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Zip | 37919-7422
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Country | US
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Telephone | 865-607-2692
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | DAVID FORSBERG
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Credential | MD
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Telephone | 865-281-5960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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