Provider Demographics
NPI:1184696270
Name:RADIOLOGY ASSOCIATES OF MOBILE PC
Entity type:Organization
Organization Name:RADIOLOGY ASSOCIATES OF MOBILE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-343-0040
Mailing Address - Street 1:6576 AIRPORT BLVD
Mailing Address - Street 2:BLDG C-2
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6768
Mailing Address - Country:US
Mailing Address - Phone:251-343-0040
Mailing Address - Fax:251-343-1115
Practice Address - Street 1:6576 AIRPORT BLVD
Practice Address - Street 2:BLDG C-2
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-6768
Practice Address - Country:US
Practice Address - Phone:251-343-0040
Practice Address - Fax:251-343-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL677322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC021Medicare PIN