Basic Information
| Provider Information | |||||||||
| NPI: | 1093787756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACHEN | ||||||||
| FirstName: | BYRON | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2055 NORMANDIE DRIVE | ||||||||
| Address2: | SUITE 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342696337 | ||||||||
| FaxNumber: | 3348340657 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 NORMANDIE DR | ||||||||
| Address2: | 108 | ||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361112732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342884624 | ||||||||
| FaxNumber: | 3342803628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 06/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 00010406 | AL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | ME89646 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 10406 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000075746 | 05 | AL | MEDICAID | 009945575 | 05 | AL | MEDICAID | 000035476 | 05 | AL | MEDICAID | 009973475 | 05 | AL | MEDICAID | 106719 | 05 | AL | MEDICAID | 000035477 | 05 | AL | MEDICAID | 009951035 | 05 | AL | MEDICAID | 106718 | 05 | AL | MEDICAID | 000035482 | 05 | AL | MEDICAID | 108378 | 05 | AL | MEDICAID | 270022100 | 05 | FL | MEDICAID | 000035479 | 05 | AL | MEDICAID | 000058867 | 01 | AL | IDTF | OTHER | 051504364 | 01 | AL | IDTF | OTHER | 009945565 | 05 | AL | MEDICAID | 108197 | 05 | AL | MEDICAID | 000035478 | 05 | AL | MEDICAID | 009932755 | 05 | AL | MEDICAID | 009945585 | 05 | AL | MEDICAID |