| Name: | Southern Imaging Specialists LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 20 Oct 2005 (19 years ago) (Companies founded in October 2005) |
| Entity Number: | 000-470-393 |
| Register Number: | 000470393 |
| ZIP code: | 36104 (Companies in Montgomery, 36104) |
| County: | Montgomery |
| Place of Formation: | Montgomery County |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
| Principal Address: | 465 ST LUKE DRIVEMONTGOMERY, AL 36104 |
Activities
MAGNETIC RESONANCE IMAGING FACILITY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962468256 | 2006-04-25 | 2015-03-03 | 465 SAINT LUKES DR, MONTGOMERY, AL, 361177107, US | 465 SAINT LUKES DR, MONTGOMERY, AL, 361177107, US | |||||||||||||||||||||
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| Phone | +1 334-279-8370 |
| Fax | 3342798572 |
Authorized person
| Name | MR. PATRICK G. HOWARD |
| Role | MANAGING MEMBER |
| Phone | 3372919161 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051557566 |
| State | AL |
| Name | Role |
|---|---|
| CAPITOL CORPORATE SERVICES, INC | Agent |
| Name | Role | Address |
|---|---|---|
| JOHN HAMIDE, MD | Manager | 4241 VETERANS BLVD SUITE 200METAIRIE, LA 70006 |
| Name | Role | Address |
|---|---|---|
| CAPITOL IMAGING, LLC | Member | 4241 VETERANS BLVD., SUITE 200METAIRIE, LA 70006 |
Date of last update: 14 Aug 2024
Sources: Alabama Secretary of State
