Healthcare Provider Details

I. General information

NPI: 1366915738
Provider Name (Legal Business Name): TRI- COUNTY MOBILE X-RAY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 COUNTY ROAD 1343
VINEMONT AL
35179
US

IV. Provider business mailing address

P.O. BOX 305
VINEMONT AL
35179
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-2051
  • Fax: 256-841-6399
Mailing address:
  • Phone: 256-739-2051
  • Fax: 256-841-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS CARROLL CORRY
Title or Position: OWNER
Credential: RT
Phone: 256-338-3893