Provider Demographics
NPI:1114012671
Name:DIAGNOSTIC IMAGING ASSOCIATES
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:M
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAMAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-325-0461
Mailing Address - Street 1:1745 VALLEY VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BIG STONE GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24219
Mailing Address - Country:US
Mailing Address - Phone:276-325-0461
Mailing Address - Fax:276-325-0469
Practice Address - Street 1:6108 GOV. G.C. PEERY HWY
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641
Practice Address - Country:US
Practice Address - Phone:276-325-0461
Practice Address - Fax:276-325-0469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010306282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65928798Medicaid
KY5183Medicare PIN
VAC05342Medicare PIN