Healthcare Provider Details

I. General information

NPI: 1841215621
Provider Name (Legal Business Name): BROOKWOOD DIAGNOSTIC IMAGING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BROOKWOOD BLVD STE 100
BIRMINGHAM AL
35209-6878
US

IV. Provider business mailing address

PO BOX 740799
ATLANTA GA
30374-0799
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-1000
  • Fax:
Mailing address:
  • Phone: 205-877-2453
  • Fax: 205-871-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number11009
License Number StateAL

VIII. Authorized Official

Name: MR. DALE SKRNICH
Title or Position: SR DIR, REG IMAGING OPS, TENET
Credential:
Phone: 469-893-6942