Provider Demographics
NPI:1134427057
Name:CREWE OUTPATIENT IMAGING LLC
Entity type:Organization
Organization Name:CREWE OUTPATIENT IMAGING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE ANALYST
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:615-372-5441
Mailing Address - Street 1:12522 W COLONIAL TRAIL HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CREWE
Mailing Address - State:VA
Mailing Address - Zip Code:23930-3329
Mailing Address - Country:US
Mailing Address - Phone:434-538-0028
Mailing Address - Fax:434-538-0028
Practice Address - Street 1:12522 W COLONIAL TRAIL HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:CREWE
Practice Address - State:VA
Practice Address - Zip Code:23930-3329
Practice Address - Country:US
Practice Address - Phone:434-538-0028
Practice Address - Fax:434-538-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-01
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty