MEDICARE: MARSHALL 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

General Provider Information

NPI Number	:	1760577878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-1258
Country	:	US
Telephone Number	:	205-871-4274
Fax Number	:	205-871-4301

Provider Business Practice Location Address
First Line	:	11491 US HIGHWAY 431
Second Line	:
City	:	ALBERTVILLE
State	:	AL
Zip	:	35950-0136
Country	:	US
Telephone Number	:	256-894-6950
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	KYLENE GOODWIN
Credential	:
Telephone Number	:	205-868-6209

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/11/2008

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