Basic Information
Provider Information | |||||||||
NPI: | 1598765182 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | VALLEY RADIOLOGISTS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 6825 | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 260030663 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8666841493 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2000 EOFF ST | ||||||||
Address2: |   | ||||||||
City: | WHEELING | ||||||||
State: | WV | ||||||||
PostalCode: | 260033823 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3042340123 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2005 | ||||||||
LastUpdateDate: | 07/18/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PATRIZI | ||||||||
AuthorizedOfficialFirstName: | JAMES | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 3042340123 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 2542565 | 05 | OH |   | MEDICAID | 2542056 | 05 | OH |   | MEDICAID | 2542556 | 05 | OH |   | MEDICAID | 0007059000 | 05 | WV |   | MEDICAID | 2542538 | 05 | OH |   | MEDICAID | 000000023696 | 01 | OH | BC/BS PIN NUMBER | OTHER | 2542547 | 05 | OH |   | MEDICAID | 2542583 | 05 | OH |   | MEDICAID | 2542592 | 05 | OH |   | MEDICAID | 2542529 | 05 | OH |   | MEDICAID | 2542574 | 05 | OH |   | MEDICAID |