Provider Demographics
NPI:1710285911
Name:VIRGINIA PHYSICIANS IMAGING CENTER
Entity Type:Organization
Organization Name:VIRGINIA PHYSICIANS IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFENBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-346-1790
Mailing Address - Street 1:PO BOX 70188
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23255-0188
Mailing Address - Country:US
Mailing Address - Phone:804-346-1747
Mailing Address - Fax:804-346-1799
Practice Address - Street 1:4900 COX RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6508
Practice Address - Country:US
Practice Address - Phone:804-346-1797
Practice Address - Fax:804-346-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010544112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06703OtherMEDICARE GROUP
G82613Medicare UPIN