Provider Demographics
NPI:1407985781
Name:PARKERSBURG RADIOLOGY, LLC
Entity Type:Organization
Organization Name:PARKERSBURG RADIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-422-3916
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26102-0779
Mailing Address - Country:US
Mailing Address - Phone:304-422-3916
Mailing Address - Fax:304-485-4466
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE 7
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-422-3916
Practice Address - Fax:304-485-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9315301Medicare PIN