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General NPI Number Information
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NPI Number | 1376594192
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Entity Type | Organization
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Legal Business Name | BIRMINGHAM RADIOLOGICAL GROUP PC
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 2000A SOUTHBRIDGE PKWY STE 300
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City | BIRMINGHAM
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State | AL
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Zip | 35209-7704
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Country | US
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Telephone | 205-871-4274
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Fax | 205-871-4301
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Provider Business Mailing Address
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Address Line | 2000A SOUTHBRIDGE PKWY STE 300
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City | BIRMINGHAM
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State | AL
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Zip | 35209-7704
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Country | US
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Telephone | 205-871-4274
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Fax | 205-871-4301
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Authorized Official
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Title or Position | BUSINESS MANAGER/CFO
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Name | LARRY S SIMMA
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Credential |
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Telephone | 205-871-4274
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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