Provider Demographics
NPI:1770667289
Name:MIDDLE TENNESSEE IMAGING LLC
Entity type:Organization
Organization Name:MIDDLE TENNESSEE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-724-8477
Mailing Address - Street 1:PO BOX 306512
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6545
Mailing Address - Country:US
Mailing Address - Phone:615-851-6003
Mailing Address - Fax:615-948-8488
Practice Address - Street 1:28 WHITE BRIDGE ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1466
Practice Address - Country:US
Practice Address - Phone:615-356-3999
Practice Address - Fax:615-353-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X
TNOCD00000000012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00185037OtherRAILROAD MEDICARE
TN3790913Medicaid
TN103G706948Medicare PIN