Provider Demographics
NPI:1417052358
Name:CREATIVE IMAGES
Entity type:Organization
Organization Name:CREATIVE IMAGES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LASHONDA
Authorized Official - Middle Name:DENENE
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:757-398-9101
Mailing Address - Street 1:4016 RAINTREE RD
Mailing Address - Street 2:SUITE 120A
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3700
Mailing Address - Country:US
Mailing Address - Phone:757-398-9101
Mailing Address - Fax:757-398-9102
Practice Address - Street 1:4016 RAINTREE RD
Practice Address - Street 2:SUITE 120A
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321
Practice Address - Country:US
Practice Address - Phone:757-398-9101
Practice Address - Fax:757-398-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010342686Medicaid
VA2179207OtherUNITED HEALTHCARE
VA239412OtherBLUE CROSS BLUE SHIELD
VA348464OtherBLUE CROSS BLUE SHIELD
VA010335795Medicaid
VA10013697OtherOPTIMA HEALTHCARE
VA10013697OtherOPTIMA HEALTHCARE
VA2179207OtherUNITED HEALTHCARE