MEDICARE: GRAFTON CT IMAGING 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	261QR0200X	Radiology Clinic/Center	35091	VA

General Provider Information

NPI Number	:	1982995296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAFTON CT IMAGING LLC

Provider Business Mailing Address
First Line	:	4030 GEORGE WASHINGTON MEM HWY STE A
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692-2619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4030 GEORGE WASHINGTON MEM HWY STE A
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692-2619
Country	:	US
Telephone Number	:	757-898-1598
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SCOTT GOLRICH
Credential	:
Telephone Number	:	757-898-1598

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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