Provider Demographics
NPI:1033199179
Name:BIRMINGHAM PET IMAGING INC
Entity Type:Organization
Organization Name:BIRMINGHAM PET IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-978-0347
Mailing Address - Street 1:PO BOX 18006
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8006
Mailing Address - Country:US
Mailing Address - Phone:256-533-2311
Mailing Address - Fax:256-533-2231
Practice Address - Street 1:1425 MONTGOMERY HWY
Practice Address - Street 2:SUITE 173
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-3679
Practice Address - Country:US
Practice Address - Phone:205-978-0347
Practice Address - Fax:205-978-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00139607OtherMEDICARE RR PALMETTO GBA
P00139607Medicare PIN
ALP00139607OtherMEDICARE RR PALMETTO GBA