Provider Demographics
NPI:1639122120
Name:SAND MOUNTAIN IMAGING, LLC
Entity Type:Organization
Organization Name:SAND MOUNTAIN IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUHRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-891-1226
Mailing Address - Street 1:4198 US HIGHWAY 431
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0212
Mailing Address - Country:US
Mailing Address - Phone:256-891-1226
Mailing Address - Fax:256-891-1267
Practice Address - Street 1:4198 US HIGHWAY 431
Practice Address - Street 2:SUITE B
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0212
Practice Address - Country:US
Practice Address - Phone:256-891-1226
Practice Address - Fax:256-891-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051557140Medicare ID - Type Unspecified