Provider Demographics
NPI:1689621211
Name:ALABAMA IMAGING P C
Entity Type:Organization
Organization Name:ALABAMA IMAGING P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAURENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-288-4624
Mailing Address - Street 1:2055 NORMANDIE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2732
Mailing Address - Country:US
Mailing Address - Phone:334-269-6337
Mailing Address - Fax:334-834-0657
Practice Address - Street 1:2055 NORMANDIE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-269-6337
Practice Address - Fax:334-834-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529101300Medicaid
AL529101300Medicaid
ALCH3575Medicare PIN
ALH704Medicare ID - Type UnspecifiedGROUP PAYEE NUMBER