Basic Information
| Provider Information | |||||||||
| NPI: | 1073692158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING HILL IMAGING CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 1558 | ||||||||
| Address2: | SPRING HILL IMAGING CENTER LLC | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384021558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313881286 | ||||||||
| FaxNumber: | 9313887119 | ||||||||
| Practice Location | |||||||||
| Address1: | 5421 MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | SPRING HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371742499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9314863425 | ||||||||
| FaxNumber: | 9314895844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | BREWER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9313881286 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | ODC0000000028 | TN | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3736801 | 05 | TN | MEDICAID |