Healthcare Provider Details

I. General information

NPI: 1811136146
Provider Name (Legal Business Name): BIRMINGHAM RADIOLOGICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PILOT MEDICAL DRIVE, STE 150
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

PO BOX 2514
BIRMINGHAM AL
35201
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-1971
  • Fax: 205-838-1517
Mailing address:
  • Phone: 205-871-4274
  • Fax: 205-871-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LARRY SIMMA
Title or Position: CFO
Credential:
Phone: 205-871-4274