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NPI Code Detail

MEDICARE: TRI-STATE RADIOLOGY

MEDICARE: TRI-STATE RADIOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD0000014904TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033155965
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI-STATE RADIOLOGY
Provider Business Mailing Address
First Line : PO BOX 596
Second Line :
City : TAZEWELL
State : TN
Zip : 37879-0596
Country : US
Telephone Number : 606-248-1320
Fax Number : 606-248-1518
Provider Business Practice Location Address
First Line : 1850 OLD KNOXVILLE RD
Second Line :
City : TAZEWELL
State : TN
Zip : 37879-3625
Country : US
Telephone Number : 423-626-4211
Fax Number : 606-248-1320
Authorized Official
Title or Position : PRESIDENT
Name : SUNAN VONGKASEMSIRI
Credential : M.D.
Telephone Number : 606-248-1320
Provider Enumeration Date : 06/20/2006
Last Update Date : 08/22/2020

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Directions to “TRI-STATE RADIOLOGY ” Practice Location

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