Basic Information
| Provider Information | |||||||||
| NPI: | 1649826785 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VESTAVIA DIAGNOSTIC CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 MONTGOMERY HWY STE 194 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HILLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352161879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059491806 | ||||||||
| FaxNumber: | 2058707735 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 MONTGOMERY HWY STE 194 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA HILLS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352161879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059491806 | ||||||||
| FaxNumber: | 2058707735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2019 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2059491806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.