Provider Demographics
NPI:1265671630
Name:BIRMINGHAM RADIOLOGICAL GROUP, PC
Entity Type:Organization
Organization Name:BIRMINGHAM RADIOLOGICAL GROUP, PC
Other - Org Name:PREMIER IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-871-4274
Mailing Address - Street 1:PO BOX 2514
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35201
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:100 PILOT MEDICAL DRIVE, STE 150
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-868-1971
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIRMINGHAM RADIOLOGICAL GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-09
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology