MEDICARE: BROOKWOOD DIAGNOSTIC 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	11009	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	183095	OTHER	FDA#
2	148669	OTHER	UMWA
3	33915	OTHER	HEALTH PARTNER
4	16-10435	OTHER	UHC

General Provider Information

NPI Number	:	1841215621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKWOOD DIAGNOSTIC IMAGING CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 740799
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0799
Country	:	US
Telephone Number	:	205-877-2453
Fax Number	:	205-871-0534

Provider Business Practice Location Address
First Line	:	513 BROOKWOOD BLVD STE 100
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6878
Country	:	US
Telephone Number	:	205-877-1000
Fax Number	:

Authorized Official
Title or Position	:	SR DIR, REG IMAGING OPS, TENET
Name	:	MR. DALE SKRNICH
Credential	:
Telephone Number	:	469-893-6942

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	04/28/2016

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Directions to “BROOKWOOD DIAGNOSTIC IMAGING CENTER, LLC ” Practice Location

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