Organization
TRI-STATE RADIOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUNAN VONGKASEMSIRI M.D. (PRESIDENT)
(606) 248-1320
Entity
Organization
Contact information
Practice address
1850 OLD KNOXVILLE RD, TAZEWELL, TN 37879-3625
(423) 626-4211
(606) 248-1320
Mailing address
PO BOX 596, TAZEWELL, TN 37879-0596
(606) 248-1320
(606) 248-1518
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD0000014904
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3036248
—
TN
Enumeration date
06/20/2006
Last updated
08/22/2020
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