Provider Demographics
NPI:1407373053
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:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-7376
Mailing Address - Street 1:2240 SUTHERLAND AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-2333
Mailing Address - Country:US
Mailing Address - Phone:865-584-7376
Mailing Address - Fax:865-540-3856
Practice Address - Street 1:5779 CREEKWOOD PARK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-1203
Practice Address - Country:US
Practice Address - Phone:865-635-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386745Medicaid