Provider Demographics
NPI:1629155601
Name:SUNBELT RADIOLOGY, PLLC
Entity Type:Organization
Organization Name:SUNBELT RADIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-531-6070
Mailing Address - Street 1:5500 LONAS DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3200
Mailing Address - Country:US
Mailing Address - Phone:865-531-6070
Mailing Address - Fax:865-531-2722
Practice Address - Street 1:188 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-4400
Practice Address - Country:US
Practice Address - Phone:423-784-7252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100028470Medicaid
KY7100028470Medicaid