MEDICARE: ELKE E WINGATE RDMS

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
1	247100000X	Radiologic Technologist
2	2471S1302X	Sonography Radiologic Technologist

General Provider Information

NPI Number	:	1215292826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELKE E WINGATE RDMS

Provider Business Mailing Address
First Line	:	323 SAVANNAH RDG
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37127-8331
Country	:	US
Telephone Number	:	615-210-9975
Fax Number	:

Provider Business Practice Location Address
First Line	:	323 SAVANNAH RDG
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37127-8331
Country	:	US
Telephone Number	:	615-210-9975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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Directions to “ ELKE E WINGATE RDMS” Practice Location

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