1780613984 NPI number — PLEASANT VALLEY RADIOLOGY

Table of content: (NPI 1780613984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780613984 NPI number — PLEASANT VALLEY RADIOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLEASANT VALLEY RADIOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780613984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 236
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT PLEASANT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25550-0236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-430-5726
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 VALLEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POINT PLEASANT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25550-2031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-675-4340
Provider Business Practice Location Address Fax Number:
304-675-5893
Provider Enumeration Date:
07/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AGRAWAL
Authorized Official First Name:
SURESH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
304-675-4340

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0009658000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0196694 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000172729 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA8852 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".