Basic Information
| Provider Information | |||||||||
| NPI: | 1982749461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH ALABAMA RADIOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 488 | ||||||||
| Address2: | |||||||||
| City: | CULLMAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350560488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567379416 | ||||||||
| FaxNumber: | 2567365684 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 PINE ST NW | ||||||||
| Address2: | |||||||||
| City: | HARTSELLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356402309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567513000 | ||||||||
| FaxNumber: | 2567513021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 02/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | TOLBERT | ||||||||
| AuthorizedOfficialFirstName: | CANDIS | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2567379416 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 00022188 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1407072028 | 01 | NPI | OTHER | 1891863395 | 01 | AL | NPI | OTHER | CH8123 | 01 | AL | CHAMPUS | OTHER |