Provider Demographics
NPI:1760513543
Name:ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC
Entity Type:Organization
Organization Name:ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC
Other - Org Name:UNIVERSITY RADIOLOGISTS, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
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 1:1924 ALCOA HWY
Practice Address - Street 2:ROOM N1200
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9060
Practice Address - Fax:865-544-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3386745Medicaid
TN3386745Medicaid