Provider Demographics
NPI:1376594192
Name:BIRMINGHAM RADIOLOGICAL GROUP PC
Entity Type:Organization
Organization Name:BIRMINGHAM RADIOLOGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-871-4274
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7704
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:2000A SOUTHBRIDGE PKWY
Practice Address - Street 2:STE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-7704
Practice Address - Country:US
Practice Address - Phone:205-871-4274
Practice Address - Fax:205-871-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F764Medicare ID - Type UnspecifiedMCE
I552Medicare ID - Type UnspecifiedCARRAWAY
G839Medicare ID - Type UnspecifiedCHEROKEE
F765Medicare ID - Type UnspecifiedONEONTA
F767Medicare ID - Type UnspecifiedPELL CITY
J099Medicare ID - Type UnspecifiedCULLMAN
J280Medicare ID - Type UnspecifiedCLANTON
F768Medicare ID - Type UnspecifiedSHELBY
C085Medicare ID - Type UnspecifiedMONTCLAIR
G838Medicare ID - Type UnspecifiedPRINCETON