MEDICARE: DIAGNOSTIC OUTPATIENT CENTER, INC.

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	261QR0200X	Radiology Clinic/Center

Other Identifiers

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

General Provider Information

NPI Number	:	1255358925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIAGNOSTIC OUTPATIENT CENTER, INC.

Provider Business Mailing Address
First Line	:	428 E BELL ST
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-2408
Country	:	US
Telephone Number	:	615-895-9995
Fax Number	:	615-895-9919

Provider Business Practice Location Address
First Line	:	428 E BELL ST
Second Line	:
City	:	MURFREESBORO
State	:	TN
Zip	:	37130-2408
Country	:	US
Telephone Number	:	615-895-9995
Fax Number	:	615-895-9919

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KENNETH LAFAYETTE TENPENNY
Credential	:	CNMT
Telephone Number	:	615-895-9995

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	04/24/2008

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