MEDICARE: UVA OUTPATIENT IMAGING CENTREVILLE 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	261QR0200X	Radiology Clinic/Center
2	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1972455624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UVA OUTPATIENT IMAGING CENTREVILLE LLC

Provider Business Mailing Address
First Line	:	7454 LIMESTONE DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-4007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7454 LIMESTONE DR
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-4007
Country	:	US
Telephone Number	:	571-636-9880
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	CHARLES CODER
Credential	:
Telephone Number	:	804-835-2069

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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