Provider Demographics
NPI:1902989445
Name:VANDERBILT ST. THOMAS IMAGING, GP
Entity Type:Organization
Organization Name:VANDERBILT ST. THOMAS IMAGING, GP
Other - Org Name:BELLE MEADE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-771-8668
Mailing Address - Street 1:4525 HARDING ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205
Mailing Address - Country:US
Mailing Address - Phone:615-463-3034
Mailing Address - Fax:615-463-3187
Practice Address - Street 1:4525 HARDING ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205
Practice Address - Country:US
Practice Address - Phone:615-463-3034
Practice Address - Fax:615-463-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherGROUP TAX ID NUMBER