Provider Demographics
NPI:1760743116
Name:TENNESSEE RADIOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:TENNESSEE RADIOLOGY ASSOCIATES, PLLC
Other - Org Name:COLUMBIA DIAGNOSTIC IMAGING, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-2443
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-0719
Mailing Address - Country:US
Mailing Address - Phone:931-528-2443
Mailing Address - Fax:931-528-1488
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2603
Practice Address - Country:US
Practice Address - Phone:931-528-2443
Practice Address - Fax:931-528-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6876782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty