Organization
TENNESSEE INNOVATIVE MEDICAL SERVICES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON G. FUNDERBURK MD (SOLE OWNER)
(865) 777-6880
Entity
Organization
Contact information
Practice address
116 CONCORD RD, STE 400, KNOXVILLE, TN 37934-2940
(865) 777-6880
(865) 777-6881
Mailing address
194 MARKET PLACE BLVD, KNOXVILLE, TN 37922-2337
(865) 560-8787
(865) 560-8784
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1527902
—
TN
Enumeration date
04/25/2012
Last updated
07/02/2012
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