MEDICARE: MEDICAL WEST IMAGING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center
2	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11914	OTHER	AL	INDEPENDENT PHYSIOLOGICAL

General Provider Information

NPI Number	:	1013960053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL WEST IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	995 9TH AVE SW
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-4527
Country	:	US
Telephone Number	:	205-481-7670
Fax Number	:	205-481-7397

Provider Business Practice Location Address
First Line	:	737 MEMORIAL DR
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-6029
Country	:	US
Telephone Number	:	205-428-9120
Fax Number	:	205-428-9248

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. LEE MORRISON
Credential	:
Telephone Number	:	205-428-9120

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/08/2008

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