Provider Demographics
NPI:1639469547
Name:ENT IMAGING, LLC
Entity Type:Organization
Organization Name:ENT IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEV
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-933-2952
Mailing Address - Street 1:2700 10TH AVE S
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1200
Mailing Address - Country:US
Mailing Address - Phone:205-933-2952
Mailing Address - Fax:205-933-5893
Practice Address - Street 1:2700 10TH AVE S
Practice Address - Street 2:SUITE 502
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1200
Practice Address - Country:US
Practice Address - Phone:205-933-2952
Practice Address - Fax:205-933-5893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10997207Y00000X
AL16561207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty