MEDICARE: PRO IMAGING DIAGNOSTICS, 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	2471N0900X	Nuclear Medicine Technology Radiologic Technologist
2	246XS1301X	Sonography Specialist/Technologist Cardiovascular
3	2471V0105X	Vascular Sonography Radiologic Technologist
4	2471B0102X	Bone Densitometry Radiologic Technologist
5	2471C3402X	Radiography Radiologic Technologist	61000	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902855307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO IMAGING DIAGNOSTICS, 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	:	2547 3RD AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25703-1642
Country	:	US
Telephone Number	:	304-522-7000
Fax Number	:	304-522-7662

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	05/20/2008

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Directions to “PRO IMAGING DIAGNOSTICS, LLC ” Practice Location

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