Provider Demographics
NPI:1013992023
Name:OPP IMAGING SERVICES LLC
Entity Type:Organization
Organization Name:OPP IMAGING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:334-493-3541
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:702 NORTH MAIN STREET
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-0890
Mailing Address - Country:US
Mailing Address - Phone:334-493-1103
Mailing Address - Fax:334-493-1105
Practice Address - Street 1:702 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1626
Practice Address - Country:US
Practice Address - Phone:334-493-1103
Practice Address - Fax:334-493-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051555207Medicaid
AL051555207Medicare ID - Type Unspecified
AL051555207Medicaid