Provider Demographics
NPI:1558416255
Name:VIRGIL V. WILLARD, II MD PA
Entity Type:Organization
Organization Name:VIRGIL V. WILLARD, II MD PA
Other - Org Name:CENTER FOR IMAGE DISCOVERY PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MITZE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-886-1667
Mailing Address - Street 1:1011 N LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3945
Mailing Address - Country:US
Mailing Address - Phone:336-886-1667
Mailing Address - Fax:336-886-5536
Practice Address - Street 1:1011 N LINDSAY ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3944
Practice Address - Country:US
Practice Address - Phone:336-886-1667
Practice Address - Fax:336-886-5536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC137733261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical