Provider Demographics
NPI:1053414847
Name:DIGITAL DIAGNOSTIC IMAGING INC
Entity type:Organization
Organization Name:DIGITAL DIAGNOSTIC IMAGING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:256-764-7676
Mailing Address - Street 1:416 W DR HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6101
Mailing Address - Country:US
Mailing Address - Phone:256-764-7676
Mailing Address - Fax:256-764-5955
Practice Address - Street 1:416 W DR HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6101
Practice Address - Country:US
Practice Address - Phone:256-764-7676
Practice Address - Fax:256-764-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11920293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51510288OtherBLUE CROSS BLUE SHIELD
TN3790959Medicare ID - Type Unspecified