MEDICARE: TOWN CENTER IMAGING 2 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1912702150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN CENTER IMAGING 2 LLC

Provider Business Mailing Address
First Line	:	4677 COLUMBUS ST STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6746
Country	:	US
Telephone Number	:	757-943-3660
Fax Number	:

Provider Business Practice Location Address
First Line	:	4677 COLUMBUS ST STE 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6746
Country	:	US
Telephone Number	:	757-943-3660
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CASSIE LOWE
Credential	:
Telephone Number	:	513-952-5210

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	05/07/2025

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