Provider Demographics
NPI:1982748216
Name:RENAISSANCE IMAGING SERVICES
Entity Type:Organization
Organization Name:RENAISSANCE IMAGING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-246-0814
Mailing Address - Street 1:2457 MALL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2809
Mailing Address - Country:US
Mailing Address - Phone:256-246-0814
Mailing Address - Fax:
Practice Address - Street 1:2457 MALL RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2809
Practice Address - Country:US
Practice Address - Phone:256-246-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051558791Medicaid
ALP00461978OtherRAILROAD MEDICARE
AL051558791Medicare PIN