Provider Demographics
NPI:1215268446
Name:CAHABA VALLEY IMAGING, LLC
Entity type:Organization
Organization Name:CAHABA VALLEY IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-823-0882
Mailing Address - Street 1:502 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1862
Mailing Address - Country:US
Mailing Address - Phone:205-418-1212
Mailing Address - Fax:205-418-1214
Practice Address - Street 1:201 RACQUET CLUB LANE
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124
Practice Address - Country:US
Practice Address - Phone:205-418-1212
Practice Address - Fax:205-418-1214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171892085B0100X, 2085D0003X, 2085N0904X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1104821297OtherPROVIDER NPI - PHILLIP ARTHUR TRIANTOS, MD
AL1043215114OtherPROVIDER NPI - SANDRA BALK MARTIN, MD
AL1205833761OtherPROVIDER NPI - CHARLES MICHAEL MEAD, MD
AL1043215114OtherPROVIDER NPI - SANDRA BALK MARTIN, MD
ALF35852Medicare UPIN
ALG05483Medicare UPIN