Provider Demographics
NPI:1659340636
Name:IMAGING SPECIALISTS PLLC
Entity type:Organization
Organization Name:IMAGING SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:AWH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-376-7324
Mailing Address - Street 1:750 OLD HICKORY BLVD STE 1-260
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4528
Mailing Address - Country:US
Mailing Address - Phone:615-376-7502
Mailing Address - Fax:
Practice Address - Street 1:750 OLD HICKORY BLVD STE 1-260
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4528
Practice Address - Country:US
Practice Address - Phone:615-376-7502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3076190Medicaid
TN3381043Medicaid