Basic Information
| Provider Information | |||||||||
| NPI: | 1265622427 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MIDDLE TENNESSEE RADIOLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5329 | ||||||||
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| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486030329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317718556 | ||||||||
| FaxNumber: | 9894014235 | ||||||||
| Practice Location | |||||||||
| Address1: | 481 INTERSTATE DR | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373553108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317286354 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2007 | ||||||||
| LastUpdateDate: | 09/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCABEE | ||||||||
| AuthorizedOfficialFirstName: | WENDELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9317718556 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 09/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD10823 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3036972 | 05 | TN | MEDICAID |