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Organization
LIFESCAN TENNESSEE, LLC
Active
Organization
LIFESCAN TENNESSEE, LLC
Active
Other names
Molecular Imaging Alliance of Tennessee
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT GREGORY (PRESIDENT)
(423) 477-3026
Entity
Organization
Contact information
Practice address
830 SUNCREST DR, UNIT 2, GRAY, TN 37615-3424
(423) 477-3026
(423) 477-2686
Mailing address
701 N STATE OF FRANKLIN RD, SUITE 1, JOHNSON CITY, TN 37604-3645
(423) 477-3026
(423) 477-2686
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
ODC0000000042
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3790000
—
TN
Enumeration date
10/04/2007
Last updated
09/20/2013
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