| Name: | Rural Imaging Southeast LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 20 Oct 2003 (21 years ago) |
| Entity Number: | 000-694-117 |
| Register Number: | 000694117 |
| County: | Sumter |
| Place of Formation: | Geneva County |
| Registered Office Street Address: | 781 4TH AVENUE SUITE AYORK, AL 36925 |
| Registered Office Street Address ZIP Code: | 36925 |
| Registered Office Mailing Address: | PO BOX 1YORK, AL 36925 |
| Registered Office Mailing Address ZIP Code: | 36925 |
Activities
MEDICAL/MOBILE ULTRASOUND/BONE DENSITY SERVICES
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467623264 | 2008-03-19 | 2008-10-28 | 781 4TH AVENUE NORTH SUITE A, YORK, AL, 369252103, US | 781 4TH AVE STE A, YORK, AL, 369252103, US | |||||||||||||||||||||||||||||||||||||||||||||||||
|
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| Phone | +1 334-830-7215 |
| Fax | 3342222583 |
Authorized person
| Name | MR. BOBBY BURKETT |
| Role | MANAGER |
| Phone | 3348307215 |
Taxonomy
| Taxonomy Code | 293D00000X - Physiological Laboratory |
| License Number | I2002 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 009966385 |
| State | AL |
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | 051554594 |
| State | AL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51519466 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529920840 |
| State | AL |
| Issuer | RAILROAD PROVIDER NUMBER |
| Number | P00145028 |
| State | AL |
| Name | Role |
|---|---|
| BURKETT, BOBBY | Agent |
| Name | Role |
|---|---|
| BURKETT, BOBBY | Member |
Date of last update: 15 Aug 2024
Sources: Alabama Secretary of State
