Healthcare Provider Details

I. General information

NPI: 1235265307
Provider Name (Legal Business Name): AMERICAN QUALITY IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2007
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S KANAWHA ST SUITE109
BECKLEY WV
25801-6967
US

IV. Provider business mailing address

2401 S KANAWHA ST SUITE109
BECKLEY WV
25801-6967
US

V. Phone/Fax

Practice location:
  • Phone: 304-256-8300
  • Fax: 304-256-8300
Mailing address:
  • Phone: 304-256-8300
  • Fax: 304-256-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number3400
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number3400
License Number StateWV

VIII. Authorized Official

Name: PAT SCHUMAN
Title or Position: CREDENTIALING SPECIALIST
Credential: CPCS
Phone: 304-929-6930