Basic Information
| Provider Information | |||||||||
| NPI: | 1902103047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED RADIOLOGY ASSOCIATES OF SOUTHERN TN, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5000 | ||||||||
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| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370885000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8773784643 | ||||||||
| FaxNumber: | 6155479845 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 HOSPITAL RD | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373982404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319678374 | ||||||||
| FaxNumber: | 9319678278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2011 | ||||||||
| LastUpdateDate: | 02/25/2011 | ||||||||
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| AuthorizedOfficialLastName: | ALLRED | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8773784643 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.