Basic Information
| Provider Information | |||||||||
| NPI: | 1285688655 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNICOM RADIOLOGY SERVICES, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32364 | ||||||||
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| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379302364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655316070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 401 TAKOMA AVE | ||||||||
| Address2: | |||||||||
| City: | GREENEVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377434647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236362362 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 02/24/2009 | ||||||||
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| AuthorizedOfficialLastName: | KOHNE | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MANAGER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4236362362 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3722079 | 05 | TN | MEDICAID |