Provider Demographics
NPI:1578594412
Name:CENTRAL VIRGINIA IMAGING, LLC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-944-0513
Mailing Address - Street 1:113 NATIONWIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502
Mailing Address - Country:US
Mailing Address - Phone:434-237-4004
Mailing Address - Fax:434-237-4450
Practice Address - Street 1:113 NATIONWIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-237-4004
Practice Address - Fax:434-237-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACH1862Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VAC06374Medicare ID - Type Unspecified