Provider Demographics
NPI:1003302472
Name:VCU DIAGNOSTIC SERVICES LLC
Entity Type:Organization
Organization Name:VCU DIAGNOSTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CLINICAL BUSINESS SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:PARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-828-0789
Mailing Address - Street 1:520 N 12TH ST # 315
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-5064
Mailing Address - Country:US
Mailing Address - Phone:804-828-9190
Mailing Address - Fax:804-628-2001
Practice Address - Street 1:520 N 12TH ST # 315
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5064
Practice Address - Country:US
Practice Address - Phone:804-828-9190
Practice Address - Fax:804-628-2001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTISTRY VCU
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-09
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty