NPIMap

Organization Active NPI

Southern Imaging Specialists, LLC

  • Physiological Laboratory
  • Montgomery, AL
National Provider Identifier
1962468256
Registry record updated Mar 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
Legal business name
SOUTHERN IMAGING SPECIALISTS, LLC
Practice address
465 Saint Lukes Dr
Montgomery, AL 36117-7107
Phone
(334) 279-8370
Fax
(334) 279-8572
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2015

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

Authorized official

Name
Mr. Patrick G. Howard
Title
Managing Member
Phone
(337) 291-9161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physiological Laboratory 293D00000X Primary

Addresses

Primary practice location

465 Saint Lukes Dr
Montgomery, AL 36117-7107

Mailing address

465 Saint Lukes Dr
Montgomery, AL 36117-7107
Phone (334) 279-8370

Other identifiers 1

IdentifierTypeStateIssuer
051557566MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060602000125 AL Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 2769493964 Practice locations: Montgomery, AL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

465 Saint Lukes Dr
Montgomery, AL 36117
Phone (334) 279-8370

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1962468256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 SAINT LUKES DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361177107",
            "telephone_number": "334-279-8370",
            "fax_number": "334-279-8572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 SAINT LUKES DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361177107",
            "telephone_number": "334-279-8370",
            "fax_number": "334-279-8572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN IMAGING SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2015-03-03",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "337-291-9161",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051557566",
            "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 3, 2015; 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.