Basic Information
| Provider Information | |||||||||
| NPI: | 1649330515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROVISION RADIOLOGY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 51784 | ||||||||
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| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379501784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655316070 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 DOWELL SPRINGS BLVD | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379092442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658052687 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | BARKER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8658052687 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 |
No ID Information.