Provider Demographics
NPI:1144268145
Name:PEDIATRIC RADIOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:PEDIATRIC RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-871-4274
Mailing Address - Street 1:2000A SOUTHBRIDGE PKWY
Mailing Address - Street 2:STE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7704
Mailing Address - Country:US
Mailing Address - Phone:205-871-4274
Mailing Address - Fax:205-871-4301
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:ACC STE 306
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-939-9336
Practice Address - Fax:205-939-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C044Medicare PIN