Provider Demographics
NPI:1225105497
Name:PRATT CARDIAC DIAGNOSTIC CENTER
Entity Type:Organization
Organization Name:PRATT CARDIAC DIAGNOSTIC CENTER
Other - Org Name:PRATT HEALTHCARE CARDIAC DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-345-3556
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:1451 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8424
Practice Address - Country:US
Practice Address - Phone:540-368-5384
Practice Address - Fax:540-374-3292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101018510207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA237341OtherANTHEM
VA080024148OtherMEDICARE RAILROAD
VA7277516OtherAETNA NON HMO
VACA9037OtherMCR RAILROAD GROUP
VA211753OtherMAMSI
VA3409592OtherAETNA HMO
VAC02375OtherMEDICARE GROUP
VA211753OtherMAMSI