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General NPI Number Information
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NPI Number | 1134427057
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Entity Type | Organization
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Legal Business Name | CREWE OUTPATIENT IMAGING LLC
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 12522 W COLONIAL TRAIL HWY SUITE 1
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City | CREWE
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State | VA
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Zip | 23930-3329
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Country | US
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Telephone | 434-538-0028
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Fax | 434-538-0028
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Provider Business Mailing Address
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Address Line | 12522 W COLONIAL TRAIL HWY SUITE 1
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City | CREWE
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State | VA
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Zip | 23930-3329
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Country | US
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Telephone | 434-538-0028
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Fax | 434-538-0028
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Authorized Official
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Title or Position | MANAGED CARE ANALYST
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Name | MR. LAVELLE R HARDIN
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Credential |
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Telephone | 615-372-5441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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