1457416968 NPI number — EMPORIA RADIOLOGY LLC

Table of content: MRS. STEPHANIE ANN NULL PTA (NPI 1609050558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457416968 NPI number — EMPORIA RADIOLOGY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPORIA RADIOLOGY LLC
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:
1457416968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
727 N MAIN ST
Provider Second Line Business Mailing Address:
RADIOLOGY DEPARTMENT
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23847-1274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-348-4835
Provider Business Mailing Address Fax Number:
434-348-4945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
727 N MAIN ST
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23847-1274
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-348-4835
Provider Business Practice Location Address Fax Number:
434-348-4945
Provider Enumeration Date:
12/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HIGHTOWER
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
ERNEST
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-348-4835

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  0101038733 , 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)