=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205887445
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY IMAGING CONSULTANTS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 11/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 202 MAPLEWOOD AVE
-----------------------------------------------------
City | RONCEVERTE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24970-1334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-645-4043
-----------------------------------------------------
Fax | 304-645-4713
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 671
-----------------------------------------------------
City | LEWISBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24901-0671
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-645-4043
-----------------------------------------------------
Fax | 304-645-4713
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. DAVID C. MAKI
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 304-645-4043
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------