Provider Demographics
NPI:1235265307
Name:AMERICAN QUALITY IMAGING
Entity Type:Organization
Organization Name:AMERICAN QUALITY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:304-929-6930
Mailing Address - Street 1:2401 S KANAWHA ST
Mailing Address - Street 2:SUITE109
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6967
Mailing Address - Country:US
Mailing Address - Phone:304-256-8300
Mailing Address - Fax:304-256-8300
Practice Address - Street 1:2401 S KANAWHA ST
Practice Address - Street 2:SUITE109
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6967
Practice Address - Country:US
Practice Address - Phone:304-256-8300
Practice Address - Fax:304-256-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-25
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3400261QR0200X, 261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV680100300Medicaid
WV5198071OtherMEDICARE PTAN
WV5198071OtherMEDICARE PTAN