Provider Demographics
NPI:1467623264
Name:RURAL IMAGING SOUTHEAST LLC
Entity Type:Organization
Organization Name:RURAL IMAGING SOUTHEAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKETT
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:334-830-7215
Mailing Address - Street 1:781 4TH AVENUE NORTH SUITE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:AL
Mailing Address - Zip Code:36925-2103
Mailing Address - Country:US
Mailing Address - Phone:334-830-7215
Mailing Address - Fax:334-222-2583
Practice Address - Street 1:781 4TH AVE STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:AL
Practice Address - Zip Code:36925-2103
Practice Address - Country:US
Practice Address - Phone:334-830-7215
Practice Address - Fax:334-222-2583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALI2002293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009966385Medicaid
AL051554594OtherMEDICARE PROVIDER NUMBER
AL51519466OtherBLUE CROSS BLUE SHIELD
AL529920840Medicaid
ALP00145028OtherRAILROAD PROVIDER NUMBER
ALY04515Medicare UPIN