MEDICARE: PRO IMAGING DIANOSTICS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C3402X	Radiography Radiologic Technologist	501001	WV

General Provider Information

NPI Number	:	1083871891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO IMAGING DIANOSTICS, LLC

Provider Business Mailing Address
First Line	:	2547 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-1642
Country	:	US
Telephone Number	:	304-522-7000
Fax Number	:	304-522-7662

Provider Business Practice Location Address
First Line	:	4600 ROUTE 152
Second Line	:	SUITE A
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9702
Country	:	US
Telephone Number	:	304-522-7000
Fax Number	:	304-522-7662

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CURTIS NICHOLS
Credential	:	CNMT
Telephone Number	:	304-522-7000

Provider Enumeration Date	:	05/20/2008
Last Update Date	:	05/20/2008

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