1033157185 NPI number — SHADES MOUNTAIN IMAGING PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033157185 NPI number — SHADES MOUNTAIN IMAGING PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHADES MOUNTAIN IMAGING PC
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:
1033157185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000A SOUTHBRIDGE PKWY
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-7704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-871-4274
Provider Business Mailing Address Fax Number:
205-871-4301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 MONTGOMERY HWY
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
VESTAVIA HILLS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35216-1862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-823-0882
Provider Business Practice Location Address Fax Number:
205-823-0872
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEAD
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-823-0882

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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