Healthcare Provider Details

I. General information

NPI: 1598579476
Provider Name (Legal Business Name): MOM MRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7094 UNIVERSITY CT
MONTGOMERY AL
36117-6992
US

IV. Provider business mailing address

PO BOX 242848
MONTGOMERY AL
36124-2848
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-1345
  • Fax: 334-271-1342
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MATTHEW B ALFREDS
Title or Position: OWNER/ATTORNEY
Credential:
Phone: 334-271-1345