Healthcare Provider Details

I. General information

NPI: 1760577878
Provider Name (Legal Business Name): MARSHALL IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11491 US HIGHWAY 431
ALBERTVILLE AL
35950-0136
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-1258
US

V. Phone/Fax

Practice location:
  • Phone: 256-894-6950
  • Fax:
Mailing address:
  • Phone: 205-871-4274
  • Fax: 205-871-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYLENE GOODWIN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 205-868-6209