Provider Demographics
NPI:1619265766
Name:INOVA RESTON MRI CENTER LLC
Entity Type:Organization
Organization Name:INOVA RESTON MRI CENTER LLC
Other - Org Name:FAIRFAX MRI AND IMAGING CENTER AT TYSONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-289-2048
Mailing Address - Street 1:2722 MERRILEE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4400
Mailing Address - Country:US
Mailing Address - Phone:703-698-4444
Mailing Address - Fax:703-204-0116
Practice Address - Street 1:7799 LEESBURG PIKE
Practice Address - Street 2:SUITE 104S
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22043-2408
Practice Address - Country:US
Practice Address - Phone:703-893-2820
Practice Address - Fax:703-827-2685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INOVA RESTON MRI CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-11
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC166599Medicare PIN