Provider Demographics
NPI:1225252091
Name:TENNESSEE IMAGING ALLIANCE LLC
Entity Type:Organization
Organization Name:TENNESSEE IMAGING ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-477-1815
Mailing Address - Street 1:1405 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3535
Mailing Address - Country:US
Mailing Address - Phone:931-388-2848
Mailing Address - Fax:931-388-2858
Practice Address - Street 1:1405 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3535
Practice Address - Country:US
Practice Address - Phone:931-388-2848
Practice Address - Fax:931-388-2858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNESSEE IMAGING ALLIANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3791297Medicare ID - Type Unspecified