Provider Demographics
NPI:1205418357
Name:MI PACS 2 PC
Entity Type:Organization
Organization Name:MI PACS 2 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-693-1000
Mailing Address - Street 1:265 BROOKVIEW CENTRE WAY STE 400
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4052
Mailing Address - Country:US
Mailing Address - Phone:865-693-1000
Mailing Address - Fax:
Practice Address - Street 1:520 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1529
Practice Address - Country:US
Practice Address - Phone:248-349-4290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty