Provider Demographics
NPI:1114998192
Name:MONTCLAIR ROAD IMAGING, LLC
Entity Type:Organization
Organization Name:MONTCLAIR ROAD IMAGING, LLC
Other - Org Name:IMAGESOUTH MONTCLAIR ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-256-3450
Mailing Address - Street 1:PO BOX 931108
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-1108
Mailing Address - Country:US
Mailing Address - Phone:205-995-9899
Mailing Address - Fax:205-995-1255
Practice Address - Street 1:924 MONTCLAIR RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1211
Practice Address - Country:US
Practice Address - Phone:205-592-4674
Practice Address - Fax:205-592-4670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51056277OtherBCBS - FACILITY ID #
AL1124000344OtherRUTH SNOW, MD
AL1023040409OtherN. MELINDA BERGQUIST, MD
AL51116990OtherJAMES SPANN, M.D. - BCBS OF ALABAMA
AL1610921OtherUHC - PROVIDER ID #
AL529906970Medicaid
AL1235111451OtherCECIL EILAND, MD
AL1306051164OtherJAMES SPANN, M.D., NPI #
AL470000833OtherRAILROAD MEDICARE
AL1427030642OtherROBERT EICHELBERGER, MD
AL000056277Medicare ID - Type Unspecified