Provider Demographics
NPI:1316201882
Name:WINGATE MOBILE, INC.
Entity Type:Organization
Organization Name:WINGATE MOBILE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/RT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:615-671-9808
Mailing Address - Street 1:323 SAVANNAH RDG
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-8331
Mailing Address - Country:US
Mailing Address - Phone:615-671-9808
Mailing Address - Fax:
Practice Address - Street 1:323 SAVANNAH RDG
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-8331
Practice Address - Country:US
Practice Address - Phone:615-671-9808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN346808247100000X
TN1122292471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty