Provider Demographics
NPI:1003918806
Name:PIKE RADIOLOGY
Entity Type:Organization
Organization Name:PIKE RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EAKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-670-5459
Mailing Address - Street 1:2257 TAYLOR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7790
Mailing Address - Country:US
Mailing Address - Phone:334-270-9914
Mailing Address - Fax:334-270-3195
Practice Address - Street 1:1330 HIGHWAY 231 S
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3058
Practice Address - Country:US
Practice Address - Phone:334-566-2783
Practice Address - Fax:334-670-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH842Medicare PIN