Provider Demographics
NPI:1043228471
Name:DIAGNOSTIC IMAGING ASSOCIATES P C
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING ASSOCIATES P C
Other - Org Name:RADIOLOGIST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEPONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-679-2729
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273
Mailing Address - Country:US
Mailing Address - Phone:276-679-2729
Mailing Address - Fax:276-679-0578
Practice Address - Street 1:935 VIRGINIA AVE NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1818
Practice Address - Country:US
Practice Address - Phone:276-679-2729
Practice Address - Fax:276-679-0578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA351772085R0202X
KY282582085R0202X
TN355102085R0202X
NC255732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
026544500OtherDEPT OF LABOR
099837OtherANTHEM BLUE CROSS
1397456OtherUMWA
TN4404574Medicaid
300009291OtherRAILROAD MEDICARE
VA007200781Medicaid
KY64794456OtherKY MED
099837OtherANTHEM BLUE CROSS
D94224Medicare UPIN