Provider Demographics
NPI:1205887445
Name:VALLEY IMAGING CONSULTANTS INC.
Entity type:Organization
Organization Name:VALLEY IMAGING CONSULTANTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-645-4043
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-0671
Mailing Address - Country:US
Mailing Address - Phone:304-645-4043
Mailing Address - Fax:304-645-4713
Practice Address - Street 1:202 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1334
Practice Address - Country:US
Practice Address - Phone:304-645-4043
Practice Address - Fax:304-645-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
010034200OtherFEDERAL BLACK LUNG
WVCJ3590OtherRAILROAD MEDICARE
WV0205803000Medicaid
WV001710520OtherBCBS
WV288546OtherUNITED HEALTHCARE/MAMSI
WVCJ3590OtherRAILROAD MEDICARE
WV=========01OtherWORKERS' COMP.
VA499820Medicare PIN
=========01OtherCHAMPUS
WV=========01OtherWORKERS' COMP.
WV288546OtherUNITED HEALTHCARE/MAMSI