1710285911 NPI number — VIRGINIA PHYSICIANS IMAGING CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710285911 NPI number — VIRGINIA PHYSICIANS IMAGING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA PHYSICIANS IMAGING 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:
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:
1710285911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23255-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-346-1747
Provider Business Mailing Address Fax Number:
804-346-1799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4900 COX RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
GLEN ALLEN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23060-6508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-346-1797
Provider Business Practice Location Address Fax Number:
804-346-1799
Provider Enumeration Date:
03/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
OFFENBACK
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
RADIOLOGY MANAGER
Authorized Official Telephone Number:
804-346-1790

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  0101054411 , 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: C06703 . This is a "MEDICARE GROUP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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