Provider Demographics
NPI:1689004285
Name:ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC
Entity Type:Organization
Organization Name:ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC
Other - Org Name:UNIVERSITY INTERVENTIONAL RADIOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LANGENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-584-7376
Mailing Address - Street 1:5401 KINGSTON PIKE
Mailing Address - Street 2:STE 540
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5022
Mailing Address - Country:US
Mailing Address - Phone:865-584-7376
Mailing Address - Fax:865-584-8938
Practice Address - Street 1:1926 ALCOA HWY
Practice Address - Street 2:BLDG F STE 400
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1545
Practice Address - Country:US
Practice Address - Phone:865-584-7376
Practice Address - Fax:865-584-8938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386745Medicaid
TN3386745Medicare PIN