Organization
MMDS OF KNOXVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY G TJADER (OWNER)
(823) 250-2830
Entity
Organization
Contact information
Practice address
710 MABRY HOOD RD, KNOXVILLE, TN 37932-2661
(865) 671-6637
Mailing address
710 MABRY HOOD RD, KNOXVILLE, TN 37932-2661
(865) 671-6637
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3044463
—
TN
01
—
3404463
MEDICARE
TN
Enumeration date
03/29/2006
Last updated
01/14/2008
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