1467623264 NPI number — RURAL IMAGING SOUTHEAST LLC

Table of content: (NPI 1467623264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467623264 NPI number — RURAL IMAGING SOUTHEAST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL IMAGING SOUTHEAST LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467623264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
781 4TH AVENUE NORTH SUITE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36925-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-830-7215
Provider Business Mailing Address Fax Number:
334-222-2583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
781 4TH AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36925-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-830-7215
Provider Business Practice Location Address Fax Number:
334-222-2583
Provider Enumeration Date:
03/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BURKETT
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
334-830-7215

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X , with the licence number:  I2002 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009966385 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051554594 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51519466 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529920840 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00145028 . This is a "RAILROAD PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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