Organization
MOUNTAIN EMPIRE RADIOLOGY INC PC
Active
Organization
MOUNTAIN EMPIRE RADIOLOGY INC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID C LUCAS (PRACTICE ADMINISTRATOR)
(423) 926-4966
Entity
Organization
Contact information
Practice address
1301 SUNSET DR, STE 3, JOHNSON CITY, TN 37604-7906
(423) 926-4966
(423) 926-1823
Mailing address
1301 SUNSET DR, STE 3, JOHNSON CITY, TN 37604-7906
(423) 926-4966
(423) 926-1823
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3378531
—
TN
01
—
65927972
KENTUCKY MEDICAID
KY
01
—
8902245
NORTH CAROLINA MEDICAID
NC
Enumeration date
05/28/2006
Last updated
08/22/2020
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