Provider Demographics
NPI:1154658102
Name:ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC
Entity Type:Organization
Organization Name:ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC
Other - Org Name:UNIVERSITY RADIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:865-584-7376
Mailing Address - Street 1:5401 KINGSTON PIKE
Mailing Address - Street 2:STE 540
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5022
Mailing Address - Country:US
Mailing Address - Phone:865-584-7673
Mailing Address - Fax:865-584-8938
Practice Address - Street 1:1415 OLD WEISGARBER RD
Practice Address - Street 2:STE 120
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-1292
Practice Address - Country:US
Practice Address - Phone:865-684-2600
Practice Address - Fax:865-684-2619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386745Medicaid
TN3386745Medicaid