Provider Demographics
NPI:1942397641
Name:BUFORD ROAD IMAGING LLC
Entity Type:Organization
Organization Name:BUFORD ROAD IMAGING LLC
Other - Org Name:THREE CHOPT IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-8203
Mailing Address - Street 1:8923 THREE CHOPT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4660
Mailing Address - Country:US
Mailing Address - Phone:804-285-9729
Mailing Address - Fax:804-282-8204
Practice Address - Street 1:8923 THREE CHOPT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4660
Practice Address - Country:US
Practice Address - Phone:804-285-9729
Practice Address - Fax:804-282-8204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1200X, 261QR0206X
VA261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA246526OtherANTHEM BCBS
VA10353459Medicaid
VAFVXUV4Medicare PIN