Rural Imaging Southeast LLC

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

License

I2002 Issued in AL

Legal business name

RURAL IMAGING SOUTHEAST LLC

Practice address

781 4TH Ave Ste a
York, AL 36925-2103

Phone

(334) 830-7215

Fax

(334) 222-2583

NPI assigned

Mar 19, 2008

Last updated

Oct 28, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bobby Burkett, ARRT

Title

Manager

Phone

(334) 830-7215

Specialties & licenses 1

Addresses

Other identifiers 5

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1205884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1467623264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 4TH AVENUE NORTH SUITE A",
            "city": "YORK",
            "state": "AL",
            "postal_code": "369252103",
            "telephone_number": "334-830-7215",
            "fax_number": "334-222-2583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 4TH AVE STE A",
            "city": "YORK",
            "state": "AL",
            "postal_code": "369252103",
            "telephone_number": "334-830-7215",
            "fax_number": "334-222-2583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RURAL IMAGING SOUTHEAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-19",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "BURKETT",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "334-830-7215",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ARRT"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "AL",
            "license": "I2002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529920840",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD PROVIDER NUMBER",
            "identifier": "P00145028",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "051554594",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009966385",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51519466",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physiological Laboratory in York, AL
• Providers in York, AL by specialty
• Physiological Laboratory in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.