1023046604 NPI number — MONTGOMERY RADIOLOGY ASSOCIATES, PA

Table of content: (NPI 1023046604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023046604 NPI number — MONTGOMERY RADIOLOGY ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY RADIOLOGY ASSOCIATES, PA
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:
1023046604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 830525, DEPT #SF128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35283-0525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-889-8610
Provider Business Mailing Address Fax Number:
706-653-1162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 NORMANDIE DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36111-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-288-4624
Provider Business Practice Location Address Fax Number:
334-280-3628
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CRIST
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
JORDAN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
334-288-4624

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000060159 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018362600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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