Provider Demographics
NPI:1063694180
Name:RADIOLOGY CONSULTANTS OF LYNCHBURG
Entity type:Organization
Organization Name:RADIOLOGY CONSULTANTS OF LYNCHBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLEEN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-237-4004
Mailing Address - Street 1:113 NATIONWIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4272
Mailing Address - Country:US
Mailing Address - Phone:434-237-4004
Mailing Address - Fax:434-237-4450
Practice Address - Street 1:113 NATIONWIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-237-4004
Practice Address - Fax:434-237-4450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADIOLOGY CONSULTANTS OF LYNCHBURG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-30
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA630000009Medicare PIN