Provider Demographics
NPI:1881639516
Name:MOBILE IMAGING GROUP, P.C.
Entity Type:Organization
Organization Name:MOBILE IMAGING GROUP, P.C.
Other - Org Name:RESOURCE IMAGING
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDDIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-981-3391
Mailing Address - Street 1:PO BOX 5870
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5870
Mailing Address - Country:US
Mailing Address - Phone:865-981-3391
Mailing Address - Fax:865-982-5185
Practice Address - Street 1:2726 E LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3539
Practice Address - Country:US
Practice Address - Phone:865-981-3391
Practice Address - Fax:865-982-5185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3791518Medicare Oscar/Certification