Provider Demographics
NPI:1073569901
Name:PROFESSIONAL IMAGING OF TENNESSEE
Entity Type:Organization
Organization Name:PROFESSIONAL IMAGING OF TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:901-465-7256
Mailing Address - Street 1:187 WOODBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-1220
Mailing Address - Country:US
Mailing Address - Phone:901-465-7256
Mailing Address - Fax:901-753-2896
Practice Address - Street 1:187 WOODBRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1220
Practice Address - Country:US
Practice Address - Phone:901-465-7256
Practice Address - Fax:901-753-2896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3790289Medicare ID - Type Unspecified