Provider Demographics
NPI:1114015153
Name:MONKS IMAGING LLC
Entity Type:Organization
Organization Name:MONKS IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/RT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MONKS
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:931-438-9085
Mailing Address - Street 1:108 MEDICAL CENTER BLVD
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-2741
Mailing Address - Country:US
Mailing Address - Phone:931-438-9085
Mailing Address - Fax:931-438-0960
Practice Address - Street 1:108 MEDICAL CENTER BLVD
Practice Address - Street 2:BOX 7
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-2741
Practice Address - Country:US
Practice Address - Phone:931-438-9085
Practice Address - Fax:931-438-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMDX0000003440247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3790647Medicaid
TN4011132OtherBCBS
TN3790647Medicaid
TN3790647Medicare ID - Type Unspecified