Provider Demographics
NPI:1225117187
Name:MEDSCAN IMAGING, INC.
Entity Type:Organization
Organization Name:MEDSCAN IMAGING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTER DIAGNOSTIC MEDICAL SONOGRA
Authorized Official - Prefix:PROF
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:RTRRDMS
Authorized Official - Phone:757-923-1111
Mailing Address - Street 1:4037 TAYLOR RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5535
Mailing Address - Country:US
Mailing Address - Phone:757-923-1111
Mailing Address - Fax:757-923-1111
Practice Address - Street 1:4037 TAYLOR RD
Practice Address - Street 2:SUITE D
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5535
Practice Address - Country:US
Practice Address - Phone:757-923-1111
Practice Address - Fax:757-923-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00917261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology