Healthcare Provider Details

I. General information

NPI: 1669560728
Provider Name (Legal Business Name): NORTHWEST DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42104 HIGHWAY 195
HALEYVILLE AL
35565-7053
US

IV. Provider business mailing address

2257 TAYLOR RD SUITE 200
MONTGOMERY AL
36117-7790
US

V. Phone/Fax

Practice location:
  • Phone: 205-486-2968
  • Fax:
Mailing address:
  • Phone: 334-270-9914
  • Fax: 334-270-3195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL SPRADLIN
Title or Position: PRESIDENT
Credential:
Phone: 205-655-7001