Provider Demographics
NPI:1649330515
Name:PROVISION RADIOLOGY, PLLC
Entity type:Organization
Organization Name:PROVISION RADIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-805-2687
Mailing Address - Street 1:PO BOX 51784
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-1784
Mailing Address - Country:US
Mailing Address - Phone:865-531-6070
Mailing Address - Fax:
Practice Address - Street 1:1450 DOWELL SPRINGS BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2442
Practice Address - Country:US
Practice Address - Phone:865-805-2687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3736315Medicare PIN