1962567123 NPI number — SELMA OPEN MRI, LLC

Table of content: (NPI 1962567123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962567123 NPI number — SELMA OPEN MRI, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELMA OPEN MRI, 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:
1962567123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2257 TAYLOR RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-7790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-270-9914
Provider Business Mailing Address Fax Number:
334-270-3195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 PARK PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SELMA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36701-6764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-410-0204
Provider Business Practice Location Address Fax Number:
334-410-0406
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-834-1300

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)





Copyright © 2007-2025 www.npivalidator.com