Healthcare Provider Details

I. General information

NPI: 1497813125
Provider Name (Legal Business Name): TRI- COUNTY MOBILE X RAY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 COUNTY ROAD 1343
VINEMONT AL
35179
US

IV. Provider business mailing address

PO BOX 305
VINEMONT AL
35179
US

V. Phone/Fax

Practice location:
  • Phone: 256-739-2051
  • Fax: 256-775-1317
Mailing address:
  • Phone: 256-739-2051
  • Fax: 256-775-1317

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: ARRT
Phone: 256-739-2051