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Organization

RURAL IMAGING SOUTHEAST LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. BOBBY BURKETT ARRT (MANAGER)
(334) 830-7215
Entity
Organization

Contact information

Practice address
781 4TH AVE STE A, YORK, AL 36925-2103
(334) 830-7215
(334) 222-2583
Mailing address
781 4TH AVENUE NORTH SUITE A, YORK, AL 36925-2103
(334) 830-7215
(334) 222-2583

Taxonomy

Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
I2002
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009966385
AL
01
051554594
MEDICARE PROVIDER NUMBER
AL
01
51519466
BLUE CROSS BLUE SHIELD
AL
05
529920840
AL
01
P00145028
RAILROAD PROVIDER NUMBER
AL
Enumeration date
03/19/2008
Last updated
10/28/2008
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