44D1094714 CLIA NUMBER - MIDDLE TENNESSEE IMAGING LLC DBA PREMIER RADIOLOGY HERMITAGE

Laboratory Demographics

CLIA Number: 44D1094714

Facility Name: MIDDLE TENNESSEE IMAGING LLC DBA PREMIER RADIOLOGY HERMITAGE

Facility Address:
5045 OLD HICKORY BLVD STE 100
HERMITAGE, TN
ZIP 37076
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Facility Phone Number: 615 884-7674

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1578944187

Taxonomy: 315P00000X - Intermediate Care Facility, Intellectual Disabilities
An intermediate care facility providing services for individuals with intellectual disabilities.

CLIA Record

Field Name	Field Value
CLIA Number	44D1094714
LAB Type	Practitioner Other
Facility Name	MIDDLE TENNESSEE IMAGING LLC DBA PREMIER RADIOLOGY HERMITAGE
Street	5045 OLD HICKORY BLVD STE 100
City	HERMITAGE
State	TN
ZIP	37076
Phone	615 884-7674
CertificateType	4
CertificateEffectiveDate	1/26/2023
CertificateExpirationDate	1/25/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024