Organization
FAYETTEVILLE MRI, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK B GABRIEL (PRINCIPAL)
(317) 634-2222
Entity
Organization
Contact information
Practice address
106 MEDICAL CENTER BLVD, FAYETTEVILLE, TN 37334-2684
(937) 438-7344
Mailing address
4636 LEBANON PIKE, PMB 107, HERMITAGE, TN 37076-1316
(931) 438-7344
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
NA
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1640521
UNITED HEALTHCARE
TN
05
—
3790830
—
TN
Enumeration date
09/19/2005
Last updated
08/22/2020
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