Provider Demographics
NPI:1912911538
Name:PHARES RADIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:PHARES RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-699-1632
Mailing Address - Street 1:2717 ALTADENA RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4506
Mailing Address - Country:US
Mailing Address - Phone:205-699-1632
Mailing Address - Fax:766-546-2124
Practice Address - Street 1:48 MEDICAL PARK DR E
Practice Address - Street 2:SUITE 356
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3400
Practice Address - Country:US
Practice Address - Phone:205-640-4623
Practice Address - Fax:866-546-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL137422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00317620OtherRR MEDICARE PIN
AL51532841OtherPAMELA KULBACK M.D. BCBS
ALDE8136OtherRR MCR
AL=========OtherTAX ID
AL51532841OtherPAMELA KULBACK M.D. BCBS
ALDE8136OtherRR MCR
ALC70953Medicare UPIN