1174851711 NPI number — CHESAPEAKE DIAGNOSTIC IMAGING CENTERS, LLC

Table of content: (NPI 1174851711)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174851711 NPI number — CHESAPEAKE DIAGNOSTIC IMAGING CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESAPEAKE DIAGNOSTIC IMAGING CENTERS, 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:
6
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:
1174851711
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1554 RIVER BIRCH RUN N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-7500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-796-5415
Provider Business Mailing Address Fax Number:
757-965-4168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 KEMPSVILLE RD
Provider Second Line Business Practice Location Address:
BUILDING C
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-4700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-671-8500
Provider Business Practice Location Address Fax Number:
757-671-7329
Provider Enumeration Date:
11/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MASON
Authorized Official First Name:
TRACEY
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
757-965-4151

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)

  • Identifier: 1174851711 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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