Provider Demographics
NPI:1336198456
Name:DIAGNOSTIC HEALTH CORPORATION
Entity Type:Organization
Organization Name:DIAGNOSTIC HEALTH CORPORATION
Other - Org Name:DIAGNOSTIC HEALTH GLEN EAGLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-685-5141
Mailing Address - Street 1:2764 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1702
Mailing Address - Country:US
Mailing Address - Phone:205-685-5000
Mailing Address - Fax:
Practice Address - Street 1:1102 GLENEAGLES DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6404
Practice Address - Country:US
Practice Address - Phone:256-882-1510
Practice Address - Fax:256-883-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51556042Medicare PIN