Provider Demographics
NPI:1447210109
Name:LECONTE RADIOLOGY PC
Entity Type:Organization
Organization Name:LECONTE RADIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:NIETHAMMER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:865-548-4004
Mailing Address - Street 1:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1445
Mailing Address - Country:US
Mailing Address - Phone:865-588-2928
Mailing Address - Fax:
Practice Address - Street 1:907 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5015
Practice Address - Country:US
Practice Address - Phone:865-548-4004
Practice Address - Fax:865-980-4962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373480Medicaid
KY65935397Medicaid
TNTN0100OtherJOHN DEERE
TNCJ2946OtherRR MCARE
TNCJ2946Medicare PIN
TN3373480Medicare PIN