Healthcare Provider Details

I. General information

NPI: 1093796781
Provider Name (Legal Business Name): ALABAMA COASTAL RADIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOBILE INFIRMARY CIRCLE
MOBILE AL
36607-3513
US

IV. Provider business mailing address

P.O. BOX 9369
MOBILE AL
36691-0369
US

V. Phone/Fax

Practice location:
  • Phone: 251-460-0326
  • Fax: 251-460-2846
Mailing address:
  • Phone: 251-460-0326
  • Fax: 251-460-2846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11359
License Number StateAL

VIII. Authorized Official

Name: DR. LEON V MCVAY III
Title or Position: PRESIDENT
Credential: MD
Phone: 251-460-0326