Provider Demographics
NPI:1508965542
Name:RADIOLOGY GROUP, P.A.
Entity Type:Organization
Organization Name:RADIOLOGY GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DAHLENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-834-3671
Mailing Address - Street 1:PO BOX 242848
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-2848
Mailing Address - Country:US
Mailing Address - Phone:334-270-9914
Mailing Address - Fax:334-270-3195
Practice Address - Street 1:1825 PARK PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1149
Practice Address - Country:US
Practice Address - Phone:334-834-3671
Practice Address - Fax:334-834-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000060023Medicaid
ALC023Medicare PIN
ALH253Medicare PIN
ALD564Medicare PIN
ALH254Medicare PIN
ALH403Medicare PIN
AL000060023Medicaid