Provider Demographics
NPI:1811994015
Name:ANNISTON RADIOLOGY GROUP, P.C.
Entity type:Organization
Organization Name:ANNISTON RADIOLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-236-3485
Mailing Address - Street 1:425 E 10TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4787
Mailing Address - Country:US
Mailing Address - Phone:256-236-3485
Mailing Address - Fax:256-237-3787
Practice Address - Street 1:425 E 10TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4787
Practice Address - Country:US
Practice Address - Phone:256-236-3485
Practice Address - Fax:256-237-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALCK1197Medicare PIN