Healthcare Provider Details

I. General information

NPI: 1295788222
Provider Name (Legal Business Name): HERITAGE DIAGNOSTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 MAIN AVE SW SUITE C
CULLMAN AL
35055-5250
US

IV. Provider business mailing address

1705 MAIN AVE SW SUITE C
CULLMAN AL
35055-5250
US

V. Phone/Fax

Practice location:
  • Phone: 256-734-8175
  • Fax: 256-734-6296
Mailing address:
  • Phone: 256-734-8175
  • Fax: 256-734-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ALAN GUTHRIE
Title or Position: ADMINISTRATOR
Credential:
Phone: 256-734-8175