Provider Demographics
NPI:1316481294
Name:ELITE IMAGING, LLC
Entity type:Organization
Organization Name:ELITE IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-991-1830
Mailing Address - Street 1:200 CAHABA PARK CIRCLE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-991-1830
Mailing Address - Fax:
Practice Address - Street 1:200 CAHABA PARK CIRCLE
Practice Address - Street 2:SUITE 215
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-991-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL15968174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty