Provider Demographics
NPI:1336164532
Name:MCMINN MEDICAL IMAGING, PC
Entity type:Organization
Organization Name:MCMINN MEDICAL IMAGING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST; PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-744-3256
Mailing Address - Street 1:PO BOX 843
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-0843
Mailing Address - Country:US
Mailing Address - Phone:423-744-3256
Mailing Address - Fax:423-746-1484
Practice Address - Street 1:1114 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4150
Practice Address - Country:US
Practice Address - Phone:423-744-3256
Practice Address - Fax:423-746-1484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD107362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006167OtherBLUECROSS BLUESHEILD TN
TN3383885Medicaid
TN3383885OtherMEDICARE
TNCD8301OtherRAILROAD MEDICARE