1831119213 NPI number — BINFORD IMAGING & DIAGNOSTIC CENTER LLC

Table of content: DR. KALEB MARION LEO PAT KENNEASTER DO (NPI 1295363083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831119213 NPI number — BINFORD IMAGING & DIAGNOSTIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BINFORD IMAGING & DIAGNOSTIC CENTER 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:
1831119213
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22710 EXECUTIVE DR
Provider Second Line Business Mailing Address:
BINFORD IMAGING & DIAGNOSTIC CENTER LLC
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-464-0318
Provider Business Mailing Address Fax Number:
703-464-0319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5500 EAST 65TH ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-595-9891
Provider Business Practice Location Address Fax Number:
317-595-9769
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CARDUCCA
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
O
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
703-437-8330

Provider Taxonomy Codes

  • Taxonomy code: 261QM1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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