Provider Demographics
NPI:1962455006
Name:VALCOUR IMAGING LLC
Entity Type:Organization
Organization Name:VALCOUR IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WOLODYMYR
Authorized Official - Middle Name:I
Authorized Official - Last Name:BULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-563-1900
Mailing Address - Street 1:16 DEGRANDPRE WAY
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6451
Mailing Address - Country:US
Mailing Address - Phone:518-563-1900
Mailing Address - Fax:518-563-2600
Practice Address - Street 1:16 DEGRANDPRE WAY
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6451
Practice Address - Country:US
Practice Address - Phone:518-563-1900
Practice Address - Fax:518-563-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0901204R261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00281925OtherRAILROAD MEDICARE
NYP00281925OtherRAILROAD MEDICARE