Healthcare Provider Details

I. General information

NPI: 1033157185
Provider Name (Legal Business Name): SHADES MOUNTAIN IMAGING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MONTGOMERY HWY STE 101
VESTAVIA HILLS AL
35216-1862
US

IV. Provider business mailing address

2000A SOUTHBRIDGE PKWY STE 300
BIRMINGHAM AL
35209-7704
US

V. Phone/Fax

Practice location:
  • Phone: 205-823-0882
  • Fax: 205-823-0872
Mailing address:
  • Phone: 205-871-4274
  • Fax: 205-871-4301

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: CHARLES MICHAEL MEAD
Title or Position: PRESIDENT
Credential: MD
Phone: 205-823-0882