Provider Demographics
NPI:1487801429
Name:SOUTHEAST IMAGING SPECIALISTS
Entity type:Organization
Organization Name:SOUTHEAST IMAGING SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-476-0340
Mailing Address - Street 1:89 RANDOLPH ROAD
Mailing Address - Street 2:
Mailing Address - City:DRUMMONDS
Mailing Address - State:TN
Mailing Address - Zip Code:38023
Mailing Address - Country:US
Mailing Address - Phone:901-476-0340
Mailing Address - Fax:901-476-0341
Practice Address - Street 1:89 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:DRUMMONDS
Practice Address - State:TN
Practice Address - Zip Code:38023-6643
Practice Address - Country:US
Practice Address - Phone:901-603-8553
Practice Address - Fax:901-475-1140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty