Provider Demographics
NPI:1497813125
Name:TRI- COUNTY MOBILE X RAY INC.
Entity Type:Organization
Organization Name:TRI- COUNTY MOBILE X RAY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:CORRY
Authorized Official - Suffix:
Authorized Official - Credentials:ARRT
Authorized Official - Phone:256-739-2051
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:VINEMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35179
Mailing Address - Country:US
Mailing Address - Phone:256-739-2051
Mailing Address - Fax:256-775-1317
Practice Address - Street 1:693 COUNTY ROAD 1343
Practice Address - Street 2:
Practice Address - City:VINEMONT
Practice Address - State:AL
Practice Address - Zip Code:35179
Practice Address - Country:US
Practice Address - Phone:256-739-2051
Practice Address - Fax:256-775-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000055014Medicaid
TN3403914Medicare PIN
AL000055014Medicaid