1871590695 NPI number — OAK RIDGE MEDICAL IMAGING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871590695 NPI number — OAK RIDGE MEDICAL IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAK RIDGE MEDICAL IMAGING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871590695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10848
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37939-0848
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-481-1904
Provider Business Mailing Address Fax Number:
865-450-9374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
944 OAK RIDGE TPKE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-6959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-481-1904
Provider Business Practice Location Address Fax Number:
865-450-9374
Provider Enumeration Date:
07/07/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HILTON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
865-481-1904

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3707081 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".