Provider Demographics
NPI:1407980543
Name:FOUR SEASONS NUCLEAR MEDICINE, PLLC
Entity Type:Organization
Organization Name:FOUR SEASONS NUCLEAR MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAEEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-326-1132
Mailing Address - Street 1:PO BOX 1537
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-1537
Mailing Address - Country:US
Mailing Address - Phone:276-326-1132
Mailing Address - Fax:276-326-1133
Practice Address - Street 1:15A WESTWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2000
Practice Address - Country:US
Practice Address - Phone:276-326-1132
Practice Address - Fax:276-326-1137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040972174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA296801OtherANTHEM BCBS
VA1184680548Medicaid
WV4000117000Medicaid
VAP00460579OtherRAILROAD MEDICARE
VA1184680548Medicaid