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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