Healthcare Provider Details

I. General information

NPI: 1568235000
Provider Name (Legal Business Name): IMC-DIAGNOSTIC AND MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SHELL ST
SARALAND AL
36571-2202
US

IV. Provider business mailing address

1700 SPRING HILL AVE STE 100
MOBILE AL
36604-1416
US

V. Phone/Fax

Practice location:
  • Phone: 251-675-4733
  • Fax:
Mailing address:
  • Phone: 251-435-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA KIRK
Title or Position: CREDENTIALS SPECIALIST
Credential:
Phone: 251-435-1366