Provider Demographics
NPI:1003150160
Name:IMAGING NETWORK GROUP, INC.
Entity Type:Organization
Organization Name:IMAGING NETWORK GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HARRELL
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-981-2420
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-1310
Mailing Address - Country:US
Mailing Address - Phone:866-226-1424
Mailing Address - Fax:251-981-2455
Practice Address - Street 1:26831 CANAL RD STE 7
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-4125
Practice Address - Country:US
Practice Address - Phone:866-226-1424
Practice Address - Fax:251-981-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20122108305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization