Provider Demographics
NPI:1811146640
Name:AMERICAN QUALITY IMAGING
Entity type:Organization
Organization Name:AMERICAN QUALITY IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:RT(R)
Authorized Official - Phone:304-256-8300
Mailing Address - Street 1:2401 S KANAWHA ST STE 109
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6967
Mailing Address - Country:US
Mailing Address - Phone:304-256-8300
Mailing Address - Fax:304-256-8300
Practice Address - Street 1:2401 S KANAWHA ST STE 109
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6967
Practice Address - Country:US
Practice Address - Phone:304-256-8300
Practice Address - Fax:304-256-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3400261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV680100300Medicaid
WVAM5198071Medicare PIN