Provider Demographics
NPI:1508973017
Name:DECATUR HEALTH IMAGING L L C
Entity Type:Organization
Organization Name:DECATUR HEALTH IMAGING L L C
Other - Org Name:OMI MANAGEMENT OF DECATUR
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-544-3215
Mailing Address - Street 1:18201 VON KARMAN AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-1176
Mailing Address - Country:US
Mailing Address - Phone:800-544-3215
Mailing Address - Fax:
Practice Address - Street 1:1123 16TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3534
Practice Address - Country:US
Practice Address - Phone:256-350-6364
Practice Address - Fax:256-351-8436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOLECULAR IMAGING TECHNOLOGIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529922450Medicaid