1114998192 NPI number — MONTCLAIR ROAD IMAGING, LLC

Table of content: (NPI 1114998192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114998192 NPI number — MONTCLAIR ROAD IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTCLAIR ROAD IMAGING, 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:
6
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:
1114998192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 931108
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:
31193-1108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-995-9899
Provider Business Mailing Address Fax Number:
205-995-1255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
924 MONTCLAIR RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35213-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-592-4674
Provider Business Practice Location Address Fax Number:
205-592-4670
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
TRACI
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BILLING
Authorized Official Telephone Number:
706-256-3450

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51056277 . This is a "BCBS - FACILITY ID #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1124000344 . This is a "RUTH SNOW, MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1023040409 . This is a "N. MELINDA BERGQUIST, MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51116990 . This is a "JAMES SPANN, M.D. - BCBS OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1610921 . This is a "UHC - PROVIDER ID #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529906970 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1235111451 . This is a "CECIL EILAND, MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1306051164 . This is a "JAMES SPANN, M.D., NPI #" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 470000833 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1427030642 . This is a "ROBERT EICHELBERGER, MD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com