| Name: | Advanced Imaging of Alabama, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 22 Oct 2008 (16 years ago) (Companies founded in October 2008) |
| Entity Number: | 000-426-532 |
| Register Number: | 000426532 |
| ZIP code: | 35904 (Companies in Etowah, 35904) |
| County: | Etowah |
| Place of Formation: | Etowah County |
| Principal Address: | GADSDEN, AL |
| Registered Office Street Address: | 3074 WALDEN RDGADSDEN, AL 35904 |
Activities
IMAGING/SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1629221510 | 2008-10-23 | 2012-09-26 | 820 SOUTH 4TH STREET, GADSDEN, AL, 359015223, US | 1699 GOLDEN SPRINGS RD, ANNISTON, AL, 362077097, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 256-549-0008 |
| Fax | 2565490401 |
| Phone | +1 256-835-0835 |
Authorized person
| Name | DR. KENNON H HAGER |
| Role | OWNER/PHYSICIAN |
| Phone | 2565490008 |
Taxonomy
| Taxonomy Code | 2085R0202X - Diagnostic Radiology Physician |
| License Number | 17729 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS OF AL |
| Number | 510-49315 |
| State | AL |
| Issuer | MEDICAID |
| Number | 113978 |
| State | AL |
| Name | Role |
|---|---|
| HAGER, KEN | Agent |
| Name | Role |
|---|---|
| HAGER, KEN | Member |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
