Basic Information
| Provider Information | |||||||||
| NPI: | 1629155601 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUNBELT RADIOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5500 LONAS DR | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379093200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655316070 | ||||||||
| FaxNumber: | 8655312722 | ||||||||
| Practice Location | |||||||||
| Address1: | 188 HOSPITAL LN | ||||||||
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| City: | JELLICO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377624400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237847252 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 06/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | HARGIS | ||||||||
| AuthorizedOfficialFirstName: | LARRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CHIEF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8655316070 | ||||||||
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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 | 7100028470 | 05 | KY | MEDICAID |