Provider Demographics
NPI:1316050172
Name:EAST TENNESSEE MOBILE DIAGNOSTICS LLC
Entity type:Organization
Organization Name:EAST TENNESSEE MOBILE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:TROTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-694-2680
Mailing Address - Street 1:5913 WOODED ACRES DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-3924
Mailing Address - Country:US
Mailing Address - Phone:865-694-2680
Mailing Address - Fax:
Practice Address - Street 1:5913 WOODED ACRES DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-3924
Practice Address - Country:US
Practice Address - Phone:865-694-2680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier