Organization Name: | CHILDERSBURG DIAGNOSTIC IMAGING, LLC |
NPI Number: | 1851476261 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MIKE BICE (ADMINISTRATOR) |
Mailing Address: | 30411 Hwy 280 Childersburg |
State: | AL US |
Postal Code: | 35178 |
Phone Number: | 2563783313 |
Fax Number: | 2563783315 |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 293D00000X |
License Number: | 11948 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Laboratories |
Taxonomy Classification: | Physiological Laboratory |
Taxonomy Specialization: | |
Taxonomy Definition: | A laboratory that operates independently of a hospital and physician |