Provider Demographics
NPI:1962124883
Name:MOSAIC BREAST IMAGING PLLC
Entity type:Organization
Organization Name:MOSAIC BREAST IMAGING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-281-5960
Mailing Address - Street 1:6604 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7422
Mailing Address - Country:US
Mailing Address - Phone:865-607-2692
Mailing Address - Fax:
Practice Address - Street 1:1450 DOWELL SPRINGS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2443
Practice Address - Country:US
Practice Address - Phone:865-607-2692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty