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NPI Code Detail

MEDICARE: CENTRAL MEMPHIS REGIONAL PET IMAGING CENTER, LLC

MEDICARE: CENTRAL MEMPHIS REGIONAL PET IMAGING CENTER, LLC
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
1261QR0200XRadiology Clinic/CenterNATN

General Provider Information

NPI Number : 1295719110
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL MEMPHIS REGIONAL PET IMAGING CENTER, LLC
Provider Business Mailing Address
First Line : PO BOX 2121
Second Line :
City : MEMPHIS
State : TN
Zip : 38159-0001
Country : US
Telephone Number : 901-276-6413
Fax Number : 901-276-3838
Provider Business Practice Location Address
First Line : 1388 MADISON AVE
Second Line :
City : MEMPHIS
State : TN
Zip : 38104-2327
Country : US
Telephone Number : 901-276-6413
Fax Number : 901-276-3838
Authorized Official
Title or Position : PRINCIPAL
Name : MR. MARK GABRIEL
Credential :
Telephone Number : 317-634-2222
Provider Enumeration Date : 12/05/2005
Last Update Date : 08/22/2020

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