Provider Demographics
NPI:1053069559
Name:MIDDLE TENNESSEE IMAGING LLC
Entity Type:Organization
Organization Name:MIDDLE TENNESSEE IMAGING LLC
Other - Org Name:PREMIER RADIOLOGY WOMEN'S MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AVP, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-724-8477
Mailing Address - Street 1:PO BOX 306512
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6545
Mailing Address - Country:US
Mailing Address - Phone:615-356-3999
Mailing Address - Fax:
Practice Address - Street 1:2011 MURPHY AVE STE 601
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2220
Practice Address - Country:US
Practice Address - Phone:615-356-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology