1457755118 NPI number — OPTIMAL RADIOLOGY PARTNERS OF VIRGINIA, PLLC

Table of content: (NPI 1457755118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457755118 NPI number — OPTIMAL RADIOLOGY PARTNERS OF VIRGINIA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMAL RADIOLOGY PARTNERS OF VIRGINIA, PLLC
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:
1457755118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 REMITTANCE DRIVE
Provider Second Line Business Mailing Address:
STE 6507
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60675-6507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-851-6033
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 SKYLYN DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-573-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HALEY
Authorized Official First Name:
JASON
Authorized Official Middle Name:
BRETT
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
615-429-0957

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)





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