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General NPI Number Information
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NPI Number | 1962455006
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Entity Type | Organization
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Legal Business Name | VALCOUR IMAGING LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/15/2007
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Provider Practice Location Address
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Address Line | 16 DEGRANDPRE WAY
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City | PLATTSBURGH
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State | NY
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Zip | 12901-6451
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Country | US
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Telephone | 518-563-1900
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Fax | 518-563-2600
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Provider Business Mailing Address
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Address Line | 16 DEGRANDPRE WAY
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City | PLATTSBURGH
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State | NY
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Zip | 12901-6451
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Country | US
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Telephone | 518-563-1900
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Fax | 518-563-2600
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. WOLODYMYR I BULA
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Credential | MD
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Telephone | 518-563-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 0901204R
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License Number State | NY
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