NPIMap

Organization Active NPI

Med Tech Imaging Center LLC

  • Radiology Clinic/Center
  • Prattville, AL
National Provider Identifier
1639678550
Registry record updated Feb 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
MED TECH IMAGING CENTER LLC
Practice address
102 Medical Center Dr Ste B
Prattville, AL 36066-7286
Phone
(334) 358-1666
Fax
(334) 777-1811
NPI assigned
Feb 6, 2018
Last updated
Feb 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2018

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

Authorized official

Name
Reza Esmaili
Title
Owner
Phone
(214) 335-7333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

102 Medical Center Dr Ste B
Prattville, AL 36066-7286

Mailing address

PO Box 680066
Prattville, AL 36068-0066
Phone (334) 358-1666

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191018000010 AL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 9234460536 Practice locations: Prattville, AL

National Provider Directory

National Provider Directory

Locations

102 Medical Center Dr
Ste B
Prattville, AL 36066
Phone (334) 358-1666

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517875200000",
    "number": "1639678550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 680066",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360680066",
            "telephone_number": "334-358-1666",
            "fax_number": "334-777-1811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 MEDICAL CENTER DR STE B",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360667286",
            "telephone_number": "334-358-1666",
            "fax_number": "334-777-1811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED TECH IMAGING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-02-06",
        "status": "A",
        "authorized_official_last_name": "ESMAILI",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-335-7333"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prattville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.