Healthcare Provider Details

I. General information

NPI: 1942397641
Provider Name (Legal Business Name): BUFORD ROAD IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8923 THREE CHOPT RD SUITE 103
RICHMOND VA
23229-4660
US

IV. Provider business mailing address

8923 THREE CHOPT RD SUITE 103
RICHMOND VA
23229-4660
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-9729
  • Fax: 804-282-8204
Mailing address:
  • Phone: 804-285-9729
  • Fax: 804-282-8204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. LAVELLE R HARDIN
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 615-344-8203