1750349031 NPI number — RICHMOND WEST END DIAGNOSTIC IMAGING, LLC

Table of content: (NPI 1750349031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750349031 NPI number — RICHMOND WEST END DIAGNOSTIC IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHMOND WEST END DIAGNOSTIC IMAGING, 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:
1750349031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 931912
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31193-1912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-659-1211
Provider Business Mailing Address Fax Number:
336-774-1751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7110 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-3786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-673-4200
Provider Business Practice Location Address Fax Number:
804-673-6513
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAEFER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
770-300-0101

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , 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: 004991401 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 346563800 . This is a "DOL" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 470001621 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7946432 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 437406 . This is a "BCBS VA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com