1235265307 NPI number — AMERICAN QUALITY IMAGING

Table of content: (NPI 1235265307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235265307 NPI number — AMERICAN QUALITY IMAGING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN QUALITY IMAGING
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:
1235265307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 S KANAWHA ST
Provider Second Line Business Mailing Address:
SUITE109
Provider Business Mailing Address City Name:
BECKLEY
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25801-6967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-256-8300
Provider Business Mailing Address Fax Number:
304-256-8300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 S KANAWHA ST
Provider Second Line Business Practice Location Address:
SUITE109
Provider Business Practice Location Address City Name:
BECKLEY
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25801-6967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-256-8300
Provider Business Practice Location Address Fax Number:
304-256-8300
Provider Enumeration Date:
02/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUMAN
Authorized Official First Name:
PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
304-929-6930

Provider Taxonomy Codes

  • Taxonomy code: 261QR0208X , with the licence number:  3400 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , with the licence number: 3400 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 680100300 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5198071 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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