Provider Demographics
NPI:1982034203
Name:SUBURBAN RADIOLOGY, LLC
Entity Type:Organization
Organization Name:SUBURBAN RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RIFE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUCKABEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-386-5315
Mailing Address - Street 1:6576 AIRPORT BLVD
Mailing Address - Street 2:BLDG. A
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6768
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6576 AIRPORT BLVD
Practice Address - Street 2:BLDG. A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6768
Practice Address - Country:US
Practice Address - Phone:334-386-5315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.152332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty