MEDICARE: SAND MOUNTAIN IMAGING, 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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1639122120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAND MOUNTAIN IMAGING, LLC

Provider Business Mailing Address
First Line	:	4198 US HIGHWAY 431
Second Line	:	SUITE B
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-0212
Country	:	US
Telephone Number	:	256-891-1226
Fax Number	:	256-891-1267

Provider Business Practice Location Address
First Line	:	4198 US HIGHWAY 431
Second Line	:	SUITE B
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-0212
Country	:	US
Telephone Number	:	256-891-1226
Fax Number	:	256-891-1267

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. KRISTEN FUHRMANN
Credential	:
Telephone Number	:	256-891-1226

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	02/04/2010

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Directions to “SAND MOUNTAIN IMAGING, LLC ” Practice Location

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