1043228471 NPI number — DIAGNOSTIC IMAGING ASSOCIATES P C

Table of content: (NPI 1043228471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043228471 NPI number — DIAGNOSTIC IMAGING ASSOCIATES P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIAGNOSTIC IMAGING ASSOCIATES P C
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:
RADIOLOGIST
Provider Other Organization Name Type Code:
5
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:
1043228471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 408
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-679-2729
Provider Business Mailing Address Fax Number:
276-679-0578

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 VIRGINIA AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24273-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-679-2729
Provider Business Practice Location Address Fax Number:
276-679-0578
Provider Enumeration Date:
08/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEPONTE
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
276-679-2729

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  35177 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 28258 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 35510 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 25573 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 026544500 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 099837 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1397456 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4404574 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300009291 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007200781 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64794456 . This is a "KY MED" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".