Provider Demographics
NPI:1457644429
Name:VANDERBILT IMAGING SERVICES, LLC
Entity Type:Organization
Organization Name:VANDERBILT IMAGING SERVICES, LLC
Other - Org Name:VANDERBILT IMAGING BELLE MEADE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-936-6001
Mailing Address - Street 1:4525 HARDING PIKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2119
Mailing Address - Country:US
Mailing Address - Phone:615-352-1975
Mailing Address - Fax:615-298-4353
Practice Address - Street 1:4525 HARDING RD
Practice Address - Street 2:SUITE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2119
Practice Address - Country:US
Practice Address - Phone:615-463-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VANDERBILT IMAGING SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-24
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODC0000000004261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G478344Medicare PIN