1225105497 NPI number — PRATT CARDIAC DIAGNOSTIC CENTER

Table of content: (NPI 1225105497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225105497 NPI number — PRATT CARDIAC DIAGNOSTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRATT CARDIAC DIAGNOSTIC CENTER
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:
PRATT HEALTHCARE CARDIAC DIAGNOSTIC CENTER
Provider Other Organization Name Type Code:
3
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:
1225105497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24014-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-345-3556
Provider Business Mailing Address Fax Number:
540-342-2193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1451 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICKSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22401-8424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-368-5384
Provider Business Practice Location Address Fax Number:
540-374-3292
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
540-345-3556

Provider Taxonomy Codes

  • Taxonomy code: 207UN0901X , with the licence number:  0101018510 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 237341 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 080024148 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7277516 . This is a "AETNA NON HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: CA9037 . This is a "MCR RAILROAD GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 211753 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3409592 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: C02375 . This is a "MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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