Provider Demographics
NPI:1568449858
Name:COMMUNITY RADIOLOGY OF VIRGINIA, INC
Entity Type:Organization
Organization Name:COMMUNITY RADIOLOGY OF VIRGINIA, INC
Other - Org Name:COMMUNITY RADIOLOGY OF VA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-977-8756
Mailing Address - Street 1:2000 LEATHERWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2020
Mailing Address - Country:US
Mailing Address - Phone:304-327-7177
Mailing Address - Fax:304-327-5850
Practice Address - Street 1:2000 LEATHERWOOD LN
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2020
Practice Address - Country:US
Practice Address - Phone:276-326-1215
Practice Address - Fax:276-326-1518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007233582Medicaid
VA470000781OtherRAILROAD MEDICARE
WV0004468210Medicaid
VA007233582Medicaid