Provider Demographics
NPI:1871196212
Name:ROSS DIAGNOSTIC IMAGING MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ROSS DIAGNOSTIC IMAGING MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEERASINGHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-431-0393
Mailing Address - Street 1:1325 OLEANDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-3745
Mailing Address - Country:US
Mailing Address - Phone:213-431-0393
Mailing Address - Fax:
Practice Address - Street 1:1325 OLEANDER AVE
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23325-3745
Practice Address - Country:US
Practice Address - Phone:213-431-0393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiographyGroup - Multi-Specialty
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed TomographyGroup - Multi-Specialty
No2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1396344859OtherNPPES