Provider Demographics
NPI:1528193943
Name:BRISTOL IMAGING CENTER, LLC.
Entity Type:Organization
Organization Name:BRISTOL IMAGING CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO, BRISTOL REGIONAL MEDICAL CENTE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-844-4200
Mailing Address - Street 1:1905 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5882
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1230 VOLUNTEER PKWY
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4628
Practice Address - Country:US
Practice Address - Phone:423-844-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology