Provider Demographics
NPI:1255358925
Name:DIAGNOSTIC OUTPATIENT CENTER, INC.
Entity type:Organization
Organization Name:DIAGNOSTIC OUTPATIENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LAFAYETTE
Authorized Official - Last Name:TENPENNY
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:615-895-9995
Mailing Address - Street 1:428 E BELL ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2408
Mailing Address - Country:US
Mailing Address - Phone:615-895-9995
Mailing Address - Fax:615-895-9919
Practice Address - Street 1:428 E BELL ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2408
Practice Address - Country:US
Practice Address - Phone:615-895-9995
Practice Address - Fax:615-895-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3790362Medicaid
TN3790362Medicare ID - Type Unspecified