Provider Demographics
NPI:1912395708
Name:WEST TENNESSEE IMAGING, LLC
Entity Type:Organization
Organization Name:WEST TENNESSEE IMAGING, LLC
Other - Org Name:THE IMAGING CENTER AT WOLF RIVER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-550-6049
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7270
Mailing Address - Country:US
Mailing Address - Phone:615-261-2306
Mailing Address - Fax:855-588-3545
Practice Address - Street 1:7600 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1744
Practice Address - Country:US
Practice Address - Phone:901-312-4033
Practice Address - Fax:844-622-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10370G2269Medicare PIN