Provider Demographics
NPI:1750479812
Name:TUSCALOOSA RADIOLOGY CLINIC, P.C.
Entity Type:Organization
Organization Name:TUSCALOOSA RADIOLOGY CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-345-7000
Mailing Address - Street 1:208 MCFARLAND CIR N
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1800
Mailing Address - Country:US
Mailing Address - Phone:205-345-7000
Mailing Address - Fax:205-343-0910
Practice Address - Street 1:208 MCFARLAND CIR N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1800
Practice Address - Country:US
Practice Address - Phone:205-345-7000
Practice Address - Fax:205-343-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC-548Medicare ID - Type UnspecifiedMEDICARE GROUP PAYEE