Provider Demographics
NPI:1558482562
Name:IMAGING INTERNATIONAL
Entity Type:Organization
Organization Name:IMAGING INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-623-8105
Mailing Address - Street 1:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0208
Mailing Address - Country:US
Mailing Address - Phone:276-623-8105
Mailing Address - Fax:
Practice Address - Street 1:319 FALLS DR NW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-8093
Practice Address - Country:US
Practice Address - Phone:276-623-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010232082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08439Medicare ID - Type UnspecifiedMEDICARE GROUP BILLING