Provider Demographics
NPI:1114551132
Name:LEBANON PET SCAN CENTER, LLC
Entity Type:Organization
Organization Name:LEBANON PET SCAN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PATTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-514-6876
Mailing Address - Street 1:P.O. BOX 440149
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:615-329-0579
Practice Address - Street 1:103 PHYSICIANS WAY STE 100
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4129
Practice Address - Country:US
Practice Address - Phone:615-329-0570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty