| Name: | Lauderdale Radiology Group, L.L.P. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Registered Limited Liability Partnership |
| Status: | Exists |
| Date of registration: | 02 Jun 2005 (19 years ago) |
| Entity Number: | 000-401-284 |
| Register Number: | 000401284 |
| County: | Lauderdale |
| Place of Formation: | Lauderdale County |
| Registered Office Street Address: | 546 W ALABAMA STFLORENCE, AL 35630 |
| Registered Office Street Address ZIP Code: | 35630 |
| Principal Address: | 201 S COURT STREET SUITE 500FLORENCE, AL 35630 |
| Principal Address ZIP Code: | 35630 |
Activities
PHYSICIAN SERVICES - RADIOLOGISTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1073605762 | 2006-09-29 | 2019-07-02 | 201 S COURT STREET, SUITE 500, FLORENCE, AL, 35630, US | 1701 VETERANS DRIVE, FLORENCE, AL, 35630, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 256-768-8168 |
| Fax | 2567688322 |
Authorized person
| Name | DR. PAUL VONHERRMANN |
| Role | RADIOLOGIST |
| Phone | 2567688168 |
Taxonomy
| Taxonomy Code | 247100000X - Radiologic Technologist |
| License Number | 00006072 |
| State | AL |
| Is Primary | Yes |
| Taxonomy Code | 247100000X - Radiologic Technologist |
| License Number | D0137 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 247100000X - Radiologic Technologist |
| License Number | 00023957 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 247100000X - Radiologic Technologist |
| License Number | 00016553 |
| State | AL |
| Is Primary | No |
| Taxonomy Code | 247100000X - Radiologic Technologist |
| License Number | MD.26676 |
| State | AL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | BC |
| Number | 51519728 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009934433 |
| State | AL |
| Issuer | BC |
| Number | 51540375 |
| State | AL |
| Issuer | BC |
| Number | 51039506 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009934439 |
| State | AL |
| Issuer | MEDICAID |
| Number | 528202620 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009934437 |
| State | AL |
| Issuer | BC |
| Number | 51039286 |
| State | AL |
| Issuer | MEDICAID |
| Number | 009934434 |
| State | AL |
| Issuer | BC |
| Number | 51507878 |
| State | AL |
| Issuer | BC EAST BILYEU |
| Number | 51543162 |
| State | AL |
| Name | Role |
|---|---|
| DURHAM, RICHARD | Agent |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
