Provider Demographics
NPI:1437515665
Name:WOMENS IMAGING CENTER OF PORTSMOUTH LLC
Entity Type:Organization
Organization Name:WOMENS IMAGING CENTER OF PORTSMOUTH LLC
Other - Org Name:BREAST CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WELSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-396-6348
Mailing Address - Street 1:355 CRAWFORD ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:757-397-3400
Mailing Address - Fax:
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-397-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty