NPIMap

Organization Active NPI

Selma Radiology Associates P C

  • Specialist
  • Montgomery, AL
National Provider Identifier
1669429296
Registry record updated Mar 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SELMA RADIOLOGY ASSOCIATES P C
Practice address
2055 Normandie Dr
Suite 108
Montgomery, AL 36111-2732
Phone
(334) 269-6337
Fax
(334) 834-0657
NPI assigned
May 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2023

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

Authorized official

Name
Mr. Mark D Laurent
Title
Ceo
Phone
(334) 288-4624

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

2055 Normandie Dr
Suite 108
Montgomery, AL 36111-2732

Mailing address

2055 Normandie Dr Ste 200
Montgomery, AL 36111-2732
Phone (334) 269-6337

Other identifiers 1

IdentifierTypeStateIssuer
529915030MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, FL, TN, CA, CO, AZ, NJ, NC, VA, NY10 enrollments

Enrollment records 10

Enrollment IDStateProvider typePAC IDDetails
O20031121000535 AL Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 73 practitioners
Practice locations: Birmingham, AL; Camden, AL; Demopolis, AL; Leeds, AL; Montgomery, AL; Selma, AL
O20231013001975 FL Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 4 practitioners
Practice locations: Miami, FL; Miami Lakes, FL; Sarasota, FL; Wimauma, FL
O20240103001034 TN Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 1 practitioner
Practice locations: Nashville, TN
O20240206002695 CA Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 2 practitioners
Practice locations: Carlsbad, CA; Los Angeles, CA
O20240219003338 CO Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 1 practitioner
Practice locations: Loveland, CO; Evergreen, CO
O20240408001019 AZ Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ
O20250320000281 NJ Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 1 practitioner
Practice locations: Short Hills, NJ
O20250321000046 NC Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 1 practitioner
Practice locations: Highlands, NC
O20250404001775 VA Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 1 practitioner
Practice locations: Leesburg, VA
O20260506002743 NY Part B Supplier - Clinic/Group Practice 3870497720 Receives reassigned benefits from 1 practitioner
Practice locations: East Amherst, NY

National Provider Directory

National Provider Directory

Locations

2055 Normandie Dr
Ste 200
Montgomery, AL 36111
Phone (205) 262-0655

Practitioners & affiliated clinicians

Practitioners 83

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1669429296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2055 NORMANDIE DR STE 200",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361112732",
            "telephone_number": "334-269-6337",
            "fax_number": "334-834-0657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 NORMANDIE DR",
            "address_2": "SUITE 108",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361112732",
            "telephone_number": "334-269-6337",
            "fax_number": "334-834-0657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELMA RADIOLOGY ASSOCIATES P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "LAURENT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "334-288-4624",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529915030",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2023; 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.