1841215621 NPI number — BROOKWOOD DIAGNOSTIC IMAGING CENTER, LLC

Table of content: (NPI 1841215621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841215621 NPI number — BROOKWOOD DIAGNOSTIC IMAGING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKWOOD DIAGNOSTIC IMAGING CENTER, 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:
1841215621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 740799
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-0799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-877-2453
Provider Business Mailing Address Fax Number:
205-871-0534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 BROOKWOOD BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35209-6878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-877-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SKRNICH
Authorized Official First Name:
DALE
Authorized Official Middle Name:
Authorized Official Title or Position:
SR DIR, REG IMAGING OPS, TENET
Authorized Official Telephone Number:
469-893-6942

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  11009 , 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: 183095 . This is a "FDA#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 148669 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33915 . This is a "HEALTH PARTNER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16-10435 . This is a "UHC" identifier . This identifiers is of the category "OTHER".