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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

ID Information
IDTypeStateIssuerDescription
254256505OH MEDICAID
254205605OH MEDICAID
254255605OH MEDICAID
000705900005WV MEDICAID
254253805OH MEDICAID
00000002369601OHBC/BS PIN NUMBEROTHER
254254705OH MEDICAID
254258305OH MEDICAID
254259205OH MEDICAID
254252905OH MEDICAID
254257405OH MEDICAID


Home