Provider Demographics
NPI:1013523687
Name:IV MEDICAL DIAGNOSTICS, PC
Entity Type:Organization
Organization Name:IV MEDICAL DIAGNOSTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYON
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-656-6464
Mailing Address - Street 1:20 RUSTIC RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-6033
Mailing Address - Country:US
Mailing Address - Phone:540-656-6464
Mailing Address - Fax:
Practice Address - Street 1:361 VISTA DR
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-1054
Practice Address - Country:US
Practice Address - Phone:917-310-5925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-19
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service