MEDICARE: BROOKWOOD DIAGNOSTIC IMAGING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center	I3772	AL

General Provider Information

NPI Number	:	1538520721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKWOOD DIAGNOSTIC IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	513 BROOKWOOD BLVD
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6878
Country	:	US
Telephone Number	:	469-893-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	513 BROOKWOOD BLVD
Second Line	:	SUITE 100
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6878
Country	:	US
Telephone Number	:	469-893-2000
Fax Number	:

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	JAIKUMAR KRISHNASWAMY
Credential	:
Telephone Number	:	972-713-3500

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	08/28/2024

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