Basic Information
| Provider Information | |||||||||
| NPI: | 1326564972 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATION OF UNIVERSITY RADIOLOGISTS, PC | ||||||||
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| OtherOrganizationName: | UNIVERSITY RADIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2240 SUTHERLAND AVE STE 107 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379192333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8635847376 | ||||||||
| FaxNumber: | 8655403856 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 PROFESSIONAL PARK PVT DR | ||||||||
| Address2: | |||||||||
| City: | COLONIAL HEIGHTS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376632288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232397300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2017 | ||||||||
| LastUpdateDate: | 11/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | LANGENBERG | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8655847376 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.